Healthcare Provider Details

I. General information

NPI: 1336043256
Provider Name (Legal Business Name): JACQUELINE AVENDANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 83RD ST FL 3
JACKSON HEIGHTS NY
11372-5229
US

IV. Provider business mailing address

3737 93RD ST
JACKSON HEIGHTS NY
11372-7931
US

V. Phone/Fax

Practice location:
  • Phone: 718-639-0700
  • Fax:
Mailing address:
  • Phone: 347-335-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: