Healthcare Provider Details

I. General information

NPI: 1801967484
Provider Name (Legal Business Name): JODY CEPEDA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 CRYSTAL RUN RD STE 201
MIDDLETOWN NY
10941-4073
US

IV. Provider business mailing address

384 CRYSTAL RUN RD STE 201
MIDDLETOWN NY
10941-4073
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-8780
  • Fax: 845-692-3439
Mailing address:
  • Phone: 845-692-8780
  • Fax: 845-692-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334584-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: