Healthcare Provider Details

I. General information

NPI: 1265771406
Provider Name (Legal Business Name): BERNADETTE L MAYERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12630 146TH ST FL 8
SOUTH OZONE PARK NY
11436-1910
US

IV. Provider business mailing address

12630 146TH ST
SOUTH OZONE PARK NY
11436-1910
US

V. Phone/Fax

Practice location:
  • Phone: 347-731-1563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405167
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306284
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number340873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: