MEDICARE: MR. HELDER TIAGO MENDES APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00753100	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00753100	NJ

General Provider Information

NPI Number	:	1083130769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HELDER TIAGO MENDES APN

Provider Business Mailing Address
First Line	:	155 WILLOWBROOK BLVD STE 110-6576
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7032
Country	:	US
Telephone Number	:	201-256-1367
Fax Number	:	844-998-4198

Provider Business Practice Location Address
First Line	:	155 WILLOWBROOK BLVD STE 110-6576
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7032
Country	:	US
Telephone Number	:	978-878-1062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	09/09/2025

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