Provider Demographics
NPI:1679154033
Name:TELFAIRE, GOLDA (FNP,RN)
Entity type:Individual
Prefix:MRS
First Name:GOLDA
Middle Name:
Last Name:TELFAIRE
Suffix:
Gender:F
Credentials:FNP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 ELY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2637
Mailing Address - Country:US
Mailing Address - Phone:845-636-9772
Mailing Address - Fax:
Practice Address - Street 1:3437 ELY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2637
Practice Address - Country:US
Practice Address - Phone:845-636-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343453363LF0000X
NY654787163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty