Healthcare Provider Details

I. General information

NPI: 1518067479
Provider Name (Legal Business Name): VANESSA MARIA MEJIAS-HIRALDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA MARIA MEJIAS-HIRALDO

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

41 OVATION CT
WHITE PLAINS NY
10603-1535
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number210408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: