MEDICARE: MRS. SHERNELL NELSON-MCKENZIE

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	225X00000X	Occupational Therapist		NY

General Provider Information

NPI Number	:	1346619905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERNELL NELSON-MCKENZIE

Provider Business Mailing Address
First Line	:	3221 CORSA AVE FL 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2808
Country	:	US
Telephone Number	:	347-998-3867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 CORSA AVE FL 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2808
Country	:	US
Telephone Number	:	347-998-3867
Fax Number	:

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

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	09/24/2015

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Directions to “ MRS. SHERNELL NELSON-MCKENZIE ” Practice Location

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