Healthcare Provider Details

I. General information

NPI: 1760297667
Provider Name (Legal Business Name): EMELY JULISSA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 HUMPHREY DR
SYOSSET NY
11791-4022
US

IV. Provider business mailing address

1937 MARION DR
EAST MEADOW NY
11554-1127
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-7171
  • Fax:
Mailing address:
  • Phone: 516-426-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: