Healthcare Provider Details

I. General information

NPI: 1558226993
Provider Name (Legal Business Name): NIABI MERCEDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 FOX ST
BRONX NY
10455-2076
US

IV. Provider business mailing address

715 FOX ST
BRONX NY
10455-2076
US

V. Phone/Fax

Practice location:
  • Phone: 917-414-2499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: