Healthcare Provider Details

I. General information

NPI: 1710420559
Provider Name (Legal Business Name): TRICIA-KAY MCLEOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24333 MAYDA RD
ROSEDALE NY
11422-2331
US

IV. Provider business mailing address

24333 MAYDA RD
ROSEDALE NY
11422-2331
US

V. Phone/Fax

Practice location:
  • Phone: 347-785-7184
  • Fax:
Mailing address:
  • Phone: 347-785-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307910-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: