Healthcare Provider Details

I. General information

NPI: 1952785396
Provider Name (Legal Business Name): DEBRA MEJIA-SCOTT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LOCUST AVE
OAKDALE NY
11769-1652
US

IV. Provider business mailing address

35 ABINET CT
SELDEN NY
11784-2024
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-5900
  • Fax:
Mailing address:
  • Phone: 631-949-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number364111-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: