MEDICARE: MS. THEODORA C RAFT 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
1	363LA2200X	Adult Health Nurse Practitioner	306107	NY
2	2084P0800X	Psychiatry Physician	403307	NY

General Provider Information

NPI Number	:	1083955041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THEODORA C RAFT NP

Provider Business Mailing Address
First Line	:	7 CREST CT
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-2135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4745
Country	:	US
Telephone Number	:	187-490-7351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	01/19/2022

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