Healthcare Provider Details

I. General information

NPI: 1790677805
Provider Name (Legal Business Name): JOSBELY PENA MEJIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 2400
HAWTHORNE NY
10532-2144
US

IV. Provider business mailing address

400 COLUMBUS AVE STE 200E
VALHALLA NY
10595-1392
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-8431
  • Fax:
Mailing address:
  • Phone: 914-614-4200
  • Fax: 914-449-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: