Healthcare Provider Details

I. General information

NPI: 1083268825
Provider Name (Legal Business Name): CLEOPATRA MAACK-SCHEUBLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAIN ST STE 209
NYACK NY
10960-3109
US

IV. Provider business mailing address

99 MAIN ST STE 209
NYACK NY
10960-3109
US

V. Phone/Fax

Practice location:
  • Phone: 914-704-3070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF344177
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberF344177
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: