Provider Demographics
NPI:1831466499
Name:CYRUS-CHARLES, JULAINE NATOYA (MSN, PMHNP-BC, RN-BC)
Entity Type:Individual
Prefix:MS
First Name:JULAINE
Middle Name:NATOYA
Last Name:CYRUS-CHARLES
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC, RN-BC
Other - Prefix:MRS
Other - First Name:JULAINE
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23120 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1301
Mailing Address - Country:US
Mailing Address - Phone:182-137-3487
Mailing Address - Fax:
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402853363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health