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General NPI Number Information
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NPI Number | 1114635760
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Entity Type | Individual
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Provider Name | BRANNY FAUSTO TAVAREZ MELENDEZ FNP
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Gender | Male
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 02/28/2026
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Provider Practice Location Address
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Address Line | 3709 FLATLANDS AVE
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City | BROOKLYN
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State | NY
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Zip | 11234-3507
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Country | US
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Telephone | 717-444-7766
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Fax | 718-285-3631
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Provider Business Mailing Address
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Address Line | 102 WOODLAND AVE
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-2027
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Country | US
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Telephone | 646-698-1876
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F358918
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License Number State | NY
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