Healthcare Provider Details

I. General information

NPI: 1588925648
Provider Name (Legal Business Name): MISS ANGELICA MEJIA DE GYVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 BROADHOLLOW RD SUITE 202
MELVILLE NY
11747-3676
US

IV. Provider business mailing address

3015 33RD ST APT. 4G
ASTORIA NY
11102-1459
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-7780
  • Fax: 631-385-7795
Mailing address:
  • Phone: 347-855-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: