MEDICARE: MS. TERLYN CARLINA VELASQUEZ

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	174400000X	Specialist	2556556	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	174400000X	OTHER	NY	SPECIALIST
2	174400000X	OTHER	NY	17

General Provider Information

NPI Number	:	1720464456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERLYN CARLINA VELASQUEZ

Provider Business Mailing Address
First Line	:	105 WILLIS AVE APT 9K
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4549
Country	:	US
Telephone Number	:	917-776-0116
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 WILLIS AVE APT 9K
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4549
Country	:	US
Telephone Number	:	917-776-0116
Fax Number	:

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	08/05/2015

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