Breona Petteway

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

331074-01 Issued in NY

Practice address

206 Erie St
Syracuse, NY 13204-1608

Phone

(631) 636-1772

NPI assigned

Jul 26, 2021

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Breona Petteway Support Services Incorporated

  • Licensed Practical Nurse
  • Wyandanch, NY
  • NPI 1194674622
  NPD Authorized official

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1225701303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 W ELLIS ST",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130572527",
            "telephone_number": "631-636-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 ERIE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132041608",
            "telephone_number": "631-636-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTEWAY",
        "first_name": "BREONA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "331074-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale A Petroff, PA
• David Petroff, PA-C
• Sarah Petroff, NP-C
• Kalliopi Petropoulou, MD
• Panayotis Petrou, PHD
• Michael A Pettinelli II, LMSW
• Elizabeth Daggett Pettit
• Gianna Pezzino, MSW
• Taylor Molloy Pfau, LCSW
• Melinda Jane Pfeffer

• Licensed Practical Nurse in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.