Healthcare Provider Details

I. General information

NPI: 1073453932
Provider Name (Legal Business Name): BREANA HALLADEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10469 88TH AVE APT 3R
RICHMOND HILL NY
11418-2161
US

IV. Provider business mailing address

10469 88TH AVE APT 3R
RICHMOND HILL NY
11418-2161
US

V. Phone/Fax

Practice location:
  • Phone: 929-757-8315
  • Fax:
Mailing address:
  • Phone: 929-757-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: