Healthcare Provider Details

I. General information

NPI: 1558055814
Provider Name (Legal Business Name): MARIA ALTAGRACIA BELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 NAGLE AVE
NEW YORK NY
10040-1405
US

IV. Provider business mailing address

3159 SEDGWICK AVE PH
BRONX NY
10463-6003
US

V. Phone/Fax

Practice location:
  • Phone: 212-942-0808
  • Fax:
Mailing address:
  • Phone: 718-710-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF351865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: