Healthcare Provider Details

I. General information

NPI: 1033027073
Provider Name (Legal Business Name): KELSEY HERNANDEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N MAIN ST
SPRING VALLEY NY
10977-4906
US

IV. Provider business mailing address

42 N MAIN ST
SPRING VALLEY NY
10977-4906
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN03963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: