Individual provider Active NPI

Feed'El Phedorah Felix

  • Licensed Practical Nurse
  • West Haverstraw, NY
National Provider Identifier
1629930730
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
355192 Issued in NY
Practice address
11 McLaughlin Ave
West Haverstraw, NY 10993-1009
Phone
(845) 366-5407
NPI assigned
Nov 26, 2025
Sex
Unspecified or another gender identity
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 355192 NY Primary

Addresses

Primary practice location

11 McLaughlin Ave
West Haverstraw, NY 10993-1009

Mailing address

11 McLaughlin Ave
West Haverstraw, NY 10993-1009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
355192NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1764115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1629930730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 MCLAUGHLIN AVE",
            "city": "WEST HAVERSTRAW",
            "state": "NY",
            "postal_code": "109931009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MCLAUGHLIN AVE",
            "city": "WEST HAVERSTRAW",
            "state": "NY",
            "postal_code": "109931009",
            "telephone_number": "845-366-5407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELIX",
        "first_name": "FEED'EL PHEDORAH",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2025-11-26",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "355192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Haverstraw, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; 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.