Healthcare Provider Details

I. General information

NPI: 1184545782
Provider Name (Legal Business Name): KEIDY CEDENO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE
NEW YORK NY
10016-5421
US

IV. Provider business mailing address

214 FINGERBOARD RD APT 2
STATEN ISLAND NY
10305-3721
US

V. Phone/Fax

Practice location:
  • Phone: 347-545-2520
  • Fax:
Mailing address:
  • Phone: 914-733-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360100
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: