MEDICARE: DESTERLYN TEJADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1063301125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTERLYN TEJADA

Provider Business Mailing Address
First Line	:	1623 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1209
Country	:	US
Telephone Number	:	929-273-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2602
Country	:	US
Telephone Number	:	718-272-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	07/01/2025

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Directions to “ DESTERLYN TEJADA ” Practice Location

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