Healthcare Provider Details

I. General information

NPI: 1366048944
Provider Name (Legal Business Name): ANAI FERNANDEZ ASTUDILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 E TREMONT AVE FL 2
BRONX NY
10461-5726
US

IV. Provider business mailing address

520 JEFFERSON AVE APT 1D
BROOKLYN NY
11221
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-6272
  • Fax:
Mailing address:
  • Phone: 347-247-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: