Healthcare Provider Details

I. General information

NPI: 1215899695
Provider Name (Legal Business Name): YORDALIS LIRIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SHAKESPEARE AVE
BRONX NY
10452-3012
US

IV. Provider business mailing address

1250 SHAKESPEARE AVE
BRONX NY
10452-3012
US

V. Phone/Fax

Practice location:
  • Phone: 646-340-1306
  • Fax: 718-294-6276
Mailing address:
  • Phone: 646-340-1306
  • Fax: 718-294-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15466500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: