Healthcare Provider Details

I. General information

NPI: 1598613788
Provider Name (Legal Business Name): MRS. YANIL ROSA-BUCKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E 233RD ST APT B8
BRONX NY
10466-2808
US

IV. Provider business mailing address

655 E 233RD ST APT B8
BRONX NY
10466-2808
US

V. Phone/Fax

Practice location:
  • Phone: 646-265-4876
  • Fax:
Mailing address:
  • Phone: 646-265-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1812673241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: