MEDICARE: MRS. GOLDA TELFAIRE FNP,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	363LF0000X	Family Nurse Practitioner	343453	NY
2	163W00000X	Registered Nurse	654787	NY

General Provider Information

NPI Number	:	1679154033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GOLDA TELFAIRE FNP,RN

Provider Business Mailing Address
First Line	:	3437 ELY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2637
Country	:	US
Telephone Number	:	845-636-9772
Fax Number	:

Provider Business Practice Location Address
First Line	:	3437 ELY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2637
Country	:	US
Telephone Number	:	845-636-9772
Fax Number	:

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

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	04/17/2021

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