Healthcare Provider Details

I. General information

NPI: 1801790746
Provider Name (Legal Business Name): FULLY WELLNESS NP IN PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WHITE PLAINS RD STE 500
TARRYTOWN NY
10591-5118
US

IV. Provider business mailing address

520 WHITE PLAINS RD STE 500
TARRYTOWN NY
10591-5118
US

V. Phone/Fax

Practice location:
  • Phone: 914-708-3333
  • Fax: 914-491-3297
Mailing address:
  • Phone: 914-708-3333
  • Fax: 914-491-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YURIY BORTNIK
Title or Position: OWNER
Credential:
Phone: 914-708-3333