MEDICARE: AFEISHA KIZZYANN MODESTE HOLSEY

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	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	805666	NY

General Provider Information

NPI Number	:	1639037583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFEISHA KIZZYANN MODESTE HOLSEY

Provider Business Mailing Address
First Line	:	178 PORTERFIELD PL
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3119
Country	:	US
Telephone Number	:	516-589-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	178 PORTERFIELD PL
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3119
Country	:	US
Telephone Number	:	516-589-2447
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ AFEISHA KIZZYANN MODESTE HOLSEY ” Practice Location

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