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General NPI Number Information
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NPI Number | 1750901229
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Entity Type | Individual
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Provider Name | GRACE BERNAUDO
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Gender | Female
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 101 MINEOLA BLVD
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City | MINEOLA
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State | NY
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Zip | 11501-4089
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Country | US
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Telephone | 516-663-3511
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Fax | 516-663-2308
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Provider Business Mailing Address
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Address Line | 151 INGRAHAM LN
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-4275
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Country | US
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Telephone | 516-437-0796
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Fax |
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 516568
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 309694
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License Number State | NY
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