Yalissa Taveras, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

348494 Issued in NY

Practice address

2001 Marcus Avenue
Suite W290
Lake Success, NY 11042

Phone

(516) 465-5255

Fax

(718) 347-2240

NPI assigned

Oct 20, 2021

Last updated

Oct 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: ytaveras364756@northwell.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1215690896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 MARCUS AVENUE",
            "address_2": "SUITE W290",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "11042",
            "telephone_number": "516-465-5255",
            "fax_number": "718-347-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 MARCUS AVENUE",
            "address_2": "SUITE W290",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "11042",
            "telephone_number": "516-465-5255",
            "fax_number": "718-347-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVERAS",
        "first_name": "YALISSA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-20",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "348494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark F Sommer, DDS
• Richard Stark, MD
• Heather Sulzbach
• Susan Ramdhaney MD PC
• Mahira Tanovic, MD
• Linda Tepper, MD
• Harold Thies, MD
• Joel Douglas Thomas, CNIM
• Lynne Ann Traube, ANP, BC
• Deborah M. Ushkow, MD

• Family Nurse Practitioner in Lake Success, NY
• Providers in Lake Success, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.