Provider Demographics
NPI:1215694104
Name:CAPELLAN, IVELISSE JULIANA (NP)
Entity type:Individual
Prefix:
First Name:IVELISSE
Middle Name:JULIANA
Last Name:CAPELLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DONGAN PL APT 1K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1560
Mailing Address - Country:US
Mailing Address - Phone:212-942-3434
Mailing Address - Fax:646-918-7176
Practice Address - Street 1:30 DONGAN PL APT 1K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1560
Practice Address - Country:US
Practice Address - Phone:212-942-3434
Practice Address - Fax:646-918-7176
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405446-01363LP0808X
NYF11210411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily