Healthcare Provider Details

I. General information

NPI: 1891608592
Provider Name (Legal Business Name): MAYRA ANDREA RAGANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 PARKWOLD DR W
VALLEY STREAM NY
11580-2130
US

IV. Provider business mailing address

28 PARKWOLD DR W
VALLEY STREAM NY
11580-2130
US

V. Phone/Fax

Practice location:
  • Phone: 516-455-4077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF351334-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: