Healthcare Provider Details

I. General information

NPI: 1093677791
Provider Name (Legal Business Name): PATRICIA E MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N BROADWAY
WHITE PLAINS NY
10603-2466
US

IV. Provider business mailing address

667 RIDGE HILL BLVD
YONKERS NY
10710-7730
US

V. Phone/Fax

Practice location:
  • Phone: 914-760-6047
  • Fax:
Mailing address:
  • Phone: 914-760-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032966-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: