MEDICARE: MR. ANFERNEE CEL CALONIA PAREDES RPT

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	225100000X	Physical Therapist	055573-01	NY

General Provider Information

NPI Number	:	1356283782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANFERNEE CEL CALONIA PAREDES RPT

Provider Business Mailing Address
First Line	:	3552 64TH ST
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-2354
Country	:	US
Telephone Number	:	929-733-8142
Fax Number	:

Provider Business Practice Location Address
First Line	:	3552 64TH ST
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-2354
Country	:	US
Telephone Number	:	929-733-8142
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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