MEDICARE: KEISHA SEWELL RN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	406686	NY

General Provider Information

NPI Number	:	1275344418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA SEWELL RN

Provider Business Mailing Address
First Line	:	506 6TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3609
Country	:	US
Telephone Number	:	862-803-1324
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 BEACH 21ST ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3305
Country	:	US
Telephone Number	:	718-799-4999
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	03/14/2026

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