MEDICARE: DESIREE CHARLES

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	163W00000X	Registered Nurse	769577	NY

General Provider Information

NPI Number	:	1700223690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE CHARLES

Provider Business Mailing Address
First Line	:	9730 AVENUE L FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4432
Country	:	US
Telephone Number	:	347-499-2607
Fax Number	:

Provider Business Practice Location Address
First Line	:	9730 AVENUE L FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4432
Country	:	US
Telephone Number	:	347-499-2607
Fax Number	:

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

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	03/27/2025

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Directions to “ DESIREE CHARLES ” Practice Location

Language	Start Address	Practice Location

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