Healthcare Provider Details

I. General information

NPI: 1710871322
Provider Name (Legal Business Name): DELIA JUDY MCKENZIE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELIA JUDY MCKENZIE DELIA MCKENZIE RN

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 E 55TH ST FL 1
BROOKLYN NY
11234-1708
US

IV. Provider business mailing address

932 E 55TH ST FL 1
BROOKLYN NY
11234-1708
US

V. Phone/Fax

Practice location:
  • Phone: 347-731-2225
  • Fax:
Mailing address:
  • Phone: 347-731-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number605094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: