Healthcare Provider Details

I. General information

NPI: 1760021893
Provider Name (Legal Business Name): FEDIELIN FLORES MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 125TH ST
NEW YORK NY
10035-6000
US

IV. Provider business mailing address

2 EASTWOOD LN
VALLEY STREAM NY
11581-2409
US

V. Phone/Fax

Practice location:
  • Phone: 646-672-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number516476
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: