Healthcare Provider Details

I. General information

NPI: 1285557033
Provider Name (Legal Business Name): MARANYELIS GERVACIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 EASTON AVE
BETHLEHEM PA
18017-4204
US

IV. Provider business mailing address

2830 EASTON AVE
BETHLEHEM PA
18017-4204
US

V. Phone/Fax

Practice location:
  • Phone: 484-658-2850
  • Fax: 484-526-2052
Mailing address:
  • Phone: 484-658-2850
  • Fax: 484-526-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: