MEDICARE: MS. ANAMARIE MEDINA MS

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	174400000X	Specialist	1786284	NY

General Provider Information

NPI Number	:	1184979155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANAMARIE MEDINA MS

Provider Business Mailing Address
First Line	:	355 BRONX RIVER RD APT 5O
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10704-3413
Country	:	US
Telephone Number	:	646-305-6005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 MAMARONECK AVE STE 150
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-5222
Country	:	US
Telephone Number	:	914-328-2868
Fax Number	:	914-328-2973

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

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	12/28/2025

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