Healthcare Provider Details

I. General information

NPI: 1265519144
Provider Name (Legal Business Name): MARIA A MENDOZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

300 W 110TH ST APT 11F
NEW YORK NY
10026-4054
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6009
  • Fax: 718-918-6749
Mailing address:
  • Phone: 212-706-7398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301379-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340055-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: