Provider Demographics
NPI:1053746586
Name:PEAL, FEAFEA MOORE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:FEAFEA
Middle Name:MOORE
Last Name:PEAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3108
Mailing Address - Country:US
Mailing Address - Phone:347-858-2497
Mailing Address - Fax:
Practice Address - Street 1:14507 130TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-2234
Practice Address - Country:US
Practice Address - Phone:347-858-2497
Practice Address - Fax:718-529-1648
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337511-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily