=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629925383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETAL PSYCHIATRY, NP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2026
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 481 PENBROOKE DR STE 6
-----------------------------------------------------
City | PENFIELD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14526-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-606-3083
-----------------------------------------------------
Fax | 585-364-0100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 481 PENBROOKE DR STE 6
-----------------------------------------------------
City | PENFIELD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14526-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-606-3083
-----------------------------------------------------
Fax | 585-364-0100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | BRITTNEY SELIM
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 585-290-7847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------