Healthcare Provider Details

I. General information

NPI: 1003740242
Provider Name (Legal Business Name): KIARA MEJIA DE JESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 W BURNSIDE AVE
BRONX NY
10453-4015
US

IV. Provider business mailing address

85 W BURNSIDE AVE
BRONX NY
10453-4015
US

V. Phone/Fax

Practice location:
  • Phone: 718-716-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131218-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: