Healthcare Provider Details

I. General information

NPI: 1932062247
Provider Name (Legal Business Name): PHOENIX NP IN PSYCHIATRY AND NP IN ADULT HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12630 146TH ST
SOUTH OZONE PARK NY
11436-1910
US

IV. Provider business mailing address

12630 146TH ST
SOUTH OZONE PARK NY
11436-1910
US

V. Phone/Fax

Practice location:
  • Phone: 347-731-1563
  • Fax:
Mailing address:
  • Phone: 347-731-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE L MAYERS
Title or Position: CEO
Credential: NP
Phone: 347-731-1563