Healthcare Provider Details

I. General information

NPI: 1689534505
Provider Name (Legal Business Name): TIFFANY PACHECO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 CASTLETON AVE
STATEN ISLAND NY
10301-2028
US

IV. Provider business mailing address

18 CARNEGIE AVE
STATEN ISLAND NY
10314-3820
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-7000
  • Fax:
Mailing address:
  • Phone: 917-862-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407177
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: