BREANNA LEE FELLDIN MD
NPI 1114556628
Psychiatry & Neurology - Child & Adolescent Psychiatry in Syracuse, NY

Q: What is Breanna Felldin's NPI number?

The NPI number for Breanna Felldin is 1114556628. It was assigned to this individual provider in the NPPES registry on April 6, 2020.

Q: What is Breanna Felldin's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Q: When was this NPI record last updated?

The NPPES record for Breanna Felldin was last updated on June 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 06, 2020PECOS Enrolled

719 HARRISON ST, SYRACUSE, NY 13210(315) 464-3265(315) 464-3282 Get Directions Write a Review

NPPES record last updated: June 24, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 24, 2025, Apr 6, 2020 (2 updates tracked since 2020).

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About Breanna Lee Felldin Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BREANNA LEE FELLDIN MD (NPI 1114556628) is an individual child & adolescent psychiatry provider in Syracuse, New York, licensed in New York (331782) and active in the NPI registry since April 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1114556628

Entity TypeIndividualFemale

Primary Taxonomy2084P0804X

Provider Legal NameBREANNA LEE FELLDINCredential: MD

Location Address719 HARRISON STSyracuse, NY 13210-2695

Mailing Address719 Harrison StSyracuse, NY 13210-2695 · (315) 464-3265 · Fax (315) 464-3282

Phone(315) 464-3265

Fax(315) 464-3282

Sole ProprietorYes

Medical School CMSOtherGraduated 2020

Enumeration DateApril 6, 2020

Last NPPES UpdateJune 24, 20252 updates tracked since enumeration

NPPES CertifiedJune 24, 2025

✔ NPI 1114556628 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0804X

License✔ Licensed in NY · 331782

Definition

Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 331782 (NY)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

719 HARRISON ST, Syracuse, NY 13210

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Breanna Lee Felldin Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5395251565

PECOS Enrollment IDI20250723002963

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WURAOLA SOFOWOTE

Nurse Practitioner (Psychiatric/Mental Health)