Healthcare Provider Details
I. General information
NPI: 1154771061
Provider Name (Legal Business Name): RACHAEL A FAUSTINO CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/21/2016
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
301 MANCHESTER RD SUITE 105
POUGHKEEPSIE NY
12603-2587
US
IV. Provider business mailing address
301 MANCHESTER RD SUITE 105
POUGHKEEPSIE NY
12603-2587
US
V. Phone/Fax
- Phone: 845-452-1700
- Fax: 845-452-1752
- Phone: 845-452-1700
- Fax: 845-452-1752
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0200X |
| Taxonomy | Pediatric Registered Nurse |
| License Number | 603084 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0200X |
| Taxonomy | Pediatric Nurse Practitioner |
| License Number | 382744 |
| License Number State | NY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: