Pro Peace NP in Psychiatry PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PRO PEACE NP IN PSYCHIATRY PLLC

Practice address

981 Bay St
Staten Island, NY 10305-4903

Phone

(862) 297-3732

NPI assigned

Oct 30, 2023

Last updated

Oct 30, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Olubunmi AdetuleNPI 1245786979

Title

Owner

Phone

(862) 297-3732

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Olubunmi Adetule

  • Psychiatric/Mental Health Nurse Practitioner
  • Springfield, NJ
  • NPI 1245786979

  NY

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1346012614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 DUNDAR RD STE 207",
            "city": "SPRINGFIELD",
            "state": "NJ",
            "postal_code": "070813513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "981 BAY ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054903",
            "telephone_number": "862-297-3732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO PEACE NP IN PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "ADETULE",
        "authorized_official_first_name": "OLUBUNMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "862-297-3732"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikki Alexandra Privracky
• Dasun Priyawardhana
• Raisa Priyeva, FNP
• PRN Care Solutions, Inc.
• Pro Digital Fusion LLC
• Problems to Solve LCSW
• Matthew James Procaccini, PA
• Procare Specialty Pharmacy, LLC
• Procare Specialty Pharmacy, LLC
• Procare Wellness Center LLC

• Psychiatric/Mental Health Nurse Practitioner in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.