Provider Demographics
NPI:1154771061
Name:FAUSTINO, RACHAEL A (CPNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:FAUSTINO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:STEUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:301 MANCHESTER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2587
Mailing Address - Country:US
Mailing Address - Phone:845-452-1700
Mailing Address - Fax:845-452-1752
Practice Address - Street 1:301 MANCHESTER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2587
Practice Address - Country:US
Practice Address - Phone:845-452-1700
Practice Address - Fax:845-452-1752
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY603084163WP0200X
NY382744363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04763411Medicaid