Healthcare Provider Details

I. General information

NPI: 1326882127
Provider Name (Legal Business Name): YESENIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 3RD ST STE 260
BETHLEHEM PA
18015-2072
US

IV. Provider business mailing address

99 KNEELAND ST APT 809
BOSTON MA
02111-2439
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2460
  • Fax:
Mailing address:
  • Phone: 617-636-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: