Healthcare Provider Details

I. General information

NPI: 1053065300
Provider Name (Legal Business Name): CHINYERE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST FL 6
NEW YORK NY
10018-9537
US

IV. Provider business mailing address

307 W 38TH ST FL 6
NEW YORK NY
10018-9537
US

V. Phone/Fax

Practice location:
  • Phone: 232-695-4564
  • Fax: 212-695-4561
Mailing address:
  • Phone: 232-695-4564
  • Fax: 212-695-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: