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NPI Code Detail

MEDICARE: RACHEL ANNE MOODY NP

MEDICARE: RACHEL ANNE MOODY NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner202120260NY

General Provider Information

NPI Number : 1013675495
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL ANNE MOODY NP
Provider Business Mailing Address
First Line : 2460 BRUYNSWICK RD
Second Line :
City : WALLKILL
State : NY
Zip : 12589-3259
Country : US
Telephone Number : 251-656-0490
Fax Number :
Provider Business Practice Location Address
First Line : 3151 STONEY ST
Second Line :
City : MOHEGAN LAKE
State : NY
Zip : 10547-1913
Country : US
Telephone Number : 914-885-1995
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2021
Last Update Date : 06/28/2023

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