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General NPI Number Information
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NPI Number | 1073974143
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Entity Type | Individual
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Provider Name | TAKIYSHA MCLEOD-BALLARD
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Gender | Female
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 726 QUINCY ST FL 4
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City | BROOKLYN
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State | NY
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Zip | 11221-2210
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Country | US
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Telephone | 347-826-6167
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Fax | 917-397-3520
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Provider Business Mailing Address
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Address Line | 32 W DEAN ST
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City | FREEPORT
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State | NY
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Zip | 11520-2106
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Country | US
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Telephone | 917-757-2596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 401983
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License Number State | NY
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