MEDICARE: ANGIE HERRERA CORREA

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	:	1811824048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE HERRERA CORREA

Provider Business Mailing Address
First Line	:	38 HALF MILE RD
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 HALF MILE RD
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1721
Country	:	US
Telephone Number	:	631-902-7884
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ ANGIE HERRERA CORREA ” Practice Location

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