MEDICARE: MR. MIKKO DANE VIUDEZ PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	407437	NY

General Provider Information

NPI Number	:	1750266805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIKKO DANE VIUDEZ PMHNP-BC

Provider Business Mailing Address
First Line	:	505 W 43RD ST APT 3K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-0091
Country	:	US
Telephone Number	:	630-456-5251
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W 43RD ST APT 3K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-0091
Country	:	US
Telephone Number	:	630-456-5251
Fax Number	:

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

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	12/10/2025

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Directions to “ MR. MIKKO DANE VIUDEZ PMHNP-BC” Practice Location

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