Healthcare Provider Details

I. General information

NPI: 1588677983
Provider Name (Legal Business Name): ESTRELLA TEJADA CERASUOLO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTRELLA CALIWARA TEJADA RN, CRNA

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST LUTHERAN MEDICAL CENTER
BROOKLYN NY
11220-2559
US

IV. Provider business mailing address

4 BOBOLINK PL
YONKERS NY
10701-5367
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7476
  • Fax:
Mailing address:
  • Phone: 914-968-8455
  • Fax: 914-968-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number228835-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number023580
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: