Healthcare Provider Details

I. General information

NPI: 1255071767
Provider Name (Legal Business Name): GAMUCHIRAI CHERRY MAPFUMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

23 EASTWOOD RD
DANBURY CT
06811-3628
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-2704
  • Fax:
Mailing address:
  • Phone: 914-308-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: