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General NPI Number Information
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NPI Number | 1588677983
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Entity Type | Individual
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Provider Name | ESTRELLA TEJADA CERASUOLO CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 150 55TH ST LUTHERAN MEDICAL CENTER
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City | BROOKLYN
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State | NY
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Zip | 11220-2559
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Country | US
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Telephone | 718-630-7476
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BOBOLINK PL
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City | YONKERS
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State | NY
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Zip | 10701-5367
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Country | US
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Telephone | 914-968-8455
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Fax | 914-968-1588
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 228835-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 023580
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License Number State | IL
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