Healthcare Provider Details

I. General information

NPI: 1891521019
Provider Name (Legal Business Name): ROSANNY MINAYA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 PHELAN PL APT 3I
BRONX NY
10453-5143
US

IV. Provider business mailing address

1834 PHELAN PL APT 3I
BRONX NY
10453-5143
US

V. Phone/Fax

Practice location:
  • Phone: 718-306-7959
  • Fax:
Mailing address:
  • Phone: 718-306-7959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3079083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: