=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841629359
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA MANUEL FERREIRA NEVES DOS SANTOS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2013
-----------------------------------------------------
Last Update Date | 11/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 238 E 81ST ST APT 3B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-717-4809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 238 E 81ST ST APT 3B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-717-4809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | P91169
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------