Healthcare Provider Details

I. General information

NPI: 1235282823
Provider Name (Legal Business Name): VIVIAN S MEJIAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS STREET ST LUKES HOSPITAL
NEWBURGH NY
12550
US

IV. Provider business mailing address

11861 GRAND ISLES LN
FORT MYERS FL
33913-8372
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-4400
  • Fax: 239-768-5385
Mailing address:
  • Phone: 239-565-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME64545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: