Healthcare Provider Details

I. General information

NPI: 1528988235
Provider Name (Legal Business Name): LAUREN ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 218TH ST
QUEENS VILLAGE NY
11428-1255
US

IV. Provider business mailing address

9002 218TH ST
QUEENS VILLAGE NY
11428-1255
US

V. Phone/Fax

Practice location:
  • Phone: 347-777-0035
  • Fax:
Mailing address:
  • Phone: 347-777-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: