Healthcare Provider Details

I. General information

NPI: 1144938366
Provider Name (Legal Business Name): JASMEN LINEYDA ECHEVERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 05/28/2025
Certification Date: 05/15/2025
Deactivation Date: 04/17/2025
Reactivation Date: 05/07/2025

III. Provider practice location address

1283 YORK AVE
NEW YORK NY
10065
US

IV. Provider business mailing address

2048 SUNRISE HIGHWAY
BAYSHORE NY
11706
US

V. Phone/Fax

Practice location:
  • Phone: 646-697-0604
  • Fax:
Mailing address:
  • Phone: 319-686-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: