Breanna Nicole Vandyk, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

355846 Issued in NY

Practice address

140 Hammond St
Port Jervis, NY 12771-2607

Phone

(845) 563-8000

NPI assigned

Jun 6, 2023

Reactivated

Jan 28, 2025

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

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cornerstone Family HealthcareGroup PAC ID 4880610393, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bon Secours Community Hospital Hospital, Port Jervis, NY, CCN 330135

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DGCECD

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.

• Cornerstone Family Healthcare

  • Federally Qualified Health Center (FQHC)
  • Newburgh, NY
  • NPI 1689669079
  Medicare reassignment Care Compare group NPD
• Cornerstone Family Healthcare

  • Federally Qualified Health Center (FQHC)
  • Newburgh, NY
  • NPI 1114757515
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bon Secours Community Hospital

  • General Acute Care Hospital
  • Port Jervis, NY
  • NPI 1659360709
  Care Compare affiliation

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

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1831883404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 ROUTE 9W STE 10",
            "city": "CORNWALL",
            "state": "NY",
            "postal_code": "125181370",
            "telephone_number": "845-220-3100",
            "fax_number": "845-534-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 HAMMOND ST",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127712607",
            "telephone_number": "845-563-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDYK",
        "first_name": "BREANNA",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-06",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "deactivation_date": "2024-12-13",
        "reactivation_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "355846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tri-State Radiology, P.C.
• Lacey Anne Trimble, LCSW
• Jenna Trone
• Twin Rivers Gastroenterology, LLP
• Caroline Ellen Van Patten, M.S., CCC-SLP
• Jessica Velez
• Janice Vicaretti
• Joanne Vicaretti
• Christine Vigilio, RN
• Jessica Vitolano

• Family Nurse Practitioner in Port Jervis, NY
• Providers in Port Jervis, 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 Mar 11, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.