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NPI Code Detail

MEDICARE: MRS. FEAFEA MOORE PEAL FNP-C

MEDICARE:  MRS. FEAFEA MOORE PEAL  FNP-C
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
1363LF0000XFamily Nurse PractitionerF337511-1NY

General Provider Information

NPI Number : 1053746586
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. FEAFEA MOORE PEAL FNP-C
Provider Business Mailing Address
First Line : 14507 130TH AVE
Second Line :
City : JAMAICA
State : NY
Zip : 11436-2234
Country : US
Telephone Number : 347-858-2497
Fax Number :
Provider Business Practice Location Address
First Line : 153 4TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-3108
Country : US
Telephone Number : 212-780-2378
Fax Number : 212-505-0724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2013
Last Update Date : 10/14/2025

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