MEDICARE: GISELLE CATHERINE FERNANDES

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1770243867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELLE CATHERINE FERNANDES

Provider Business Mailing Address
First Line	:	215 W 95TH ST APT 3L
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-6340
Country	:	US
Telephone Number	:	732-567-2420
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 W 95TH ST APT 3L
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-6340
Country	:	US
Telephone Number	:	732-567-2420
Fax Number	:

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

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	12/30/2021

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