MEDICARE: PEGUY MESIDOR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	372600000X	Adult Companion
3	374U00000X	Home Health Aide
4	376J00000X	Homemaker
5	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1215485826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGUY MESIDOR

Provider Business Mailing Address
First Line	:	19138 112TH RD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-2412
Country	:	US
Telephone Number	:	347-414-3892
Fax Number	:

Provider Business Practice Location Address
First Line	:	19138 112TH RD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-2412
Country	:	US
Telephone Number	:	347-414-3892
Fax Number	:

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

Provider Enumeration Date	:	09/13/2016
Last Update Date	:	09/13/2016

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Directions to “ PEGUY MESIDOR ” Practice Location

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