Healthcare Provider Details

I. General information

NPI: 1164894226
Provider Name (Legal Business Name): SHEEBA CATHERINE PELLEGRINO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

1825 EASTCHESTER ROAD
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4032
  • Fax:
Mailing address:
  • Phone: 718-904-4032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339110-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: