Healthcare Provider Details

I. General information

NPI: 1407529225
Provider Name (Legal Business Name): JERALDINE MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 VERNON BLVD UNIT 2F
ASTORIA NY
11106-5184
US

IV. Provider business mailing address

3459 VERNON BLVD UNIT 2F
ASTORIA NY
11106-5184
US

V. Phone/Fax

Practice location:
  • Phone: 916-280-6481
  • Fax:
Mailing address:
  • Phone: 916-280-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number804121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: