Healthcare Provider Details

I. General information

NPI: 1881320455
Provider Name (Legal Business Name): MS. DENISE BEACHEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 UNION AVE
STATEN ISLAND NY
10303-2426
US

IV. Provider business mailing address

273 MAPLE PKWY # 2
STATEN ISLAND NY
10303-2464
US

V. Phone/Fax

Practice location:
  • Phone: 718-813-5945
  • Fax:
Mailing address:
  • Phone: 347-631-6589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: