Healthcare Provider Details

I. General information

NPI: 1396662938
Provider Name (Legal Business Name): MUSTAFA BAYRAM PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 87
PATCHOGUE NY
11772-0087
US

IV. Provider business mailing address

PO BOX 87
PATCHOGUE NY
11772-0087
US

V. Phone/Fax

Practice location:
  • Phone: 516-497-0467
  • Fax:
Mailing address:
  • Phone: 516-497-0467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: