MEDICARE: MRS. YANIL ROSA-BUCKLEY

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	222Q00000X	Developmental Therapist	1812673241	NY

General Provider Information

NPI Number	:	1598613788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YANIL ROSA-BUCKLEY

Provider Business Mailing Address
First Line	:	655 E 233RD ST APT B8
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2808
Country	:	US
Telephone Number	:	646-265-4876
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 E 233RD ST APT B8
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2808
Country	:	US
Telephone Number	:	646-265-4876
Fax Number	:

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

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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