Healthcare Provider Details

I. General information

NPI: 1104685932
Provider Name (Legal Business Name): MS. JAYDE CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 RICHMOND AVE
STATEN ISLAND NY
10312-2025
US

IV. Provider business mailing address

367 GRIMSBY ST
STATEN ISLAND NY
10306-5827
US

V. Phone/Fax

Practice location:
  • Phone: 718-608-9170
  • Fax:
Mailing address:
  • Phone: 917-334-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: