Provider Demographics
NPI:1376748558
Name:PAULEMON, PHEDRE PHARA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:PHEDRE
Middle Name:PHARA
Last Name:PAULEMON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MS
Other - First Name:PHARA
Other - Middle Name:
Other - Last Name:PAULEMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NP
Mailing Address - Street 1:2525 NOSTRAND AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4715
Mailing Address - Country:US
Mailing Address - Phone:954-867-6982
Mailing Address - Fax:917-933-4212
Practice Address - Street 1:2601 OCEAN PKWY
Practice Address - Street 2:PAGNY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-616-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2598428363LF0000X
NY343011363LF0000X, 363LP2300X
CT12.0095564363LF0000X
347C00000X
FLRN9406448372600000X, 163WP0808X, 163WM0705X, 163WS0200X, 372500000X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No372500000XNursing Service Related ProvidersChore Provider
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05401478Medicaid
NY83-3096541Medicaid
NY0798935OtherCIGNA