Healthcare Provider Details

I. General information

NPI: 1942371133
Provider Name (Legal Business Name): LYDIA CUEVO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 QUARRY DR
MOHEGAN LAKE NY
10547-2003
US

IV. Provider business mailing address

1345 QUARRY DR
MOHEGAN LAKE NY
10547-2003
US

V. Phone/Fax

Practice location:
  • Phone: 914-302-6230
  • Fax:
Mailing address:
  • Phone: 914-302-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number364382-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: