Healthcare Provider Details

I. General information

NPI: 1184570582
Provider Name (Legal Business Name): RAFFAELLA EYDELMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 WINTHROP PL
STATEN ISLAND NY
10314-3043
US

IV. Provider business mailing address

38 WINTHROP PL
STATEN ISLAND NY
10314-3043
US

V. Phone/Fax

Practice location:
  • Phone: 917-734-4433
  • Fax:
Mailing address:
  • Phone: 718-727-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: