Healthcare Provider Details

I. General information

NPI: 1699698787
Provider Name (Legal Business Name): YOCASTA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 OSSMAN CT
GARNERVILLE NY
10923-1539
US

IV. Provider business mailing address

60 OSSMAN CT
GARNERVILLE NY
10923-1539
US

V. Phone/Fax

Practice location:
  • Phone: 914-325-1191
  • Fax:
Mailing address:
  • Phone: 914-325-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number96224601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: