MEDICARE: LALITA N REYES FNP-C

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	775984	NY

General Provider Information

NPI Number	:	1457209322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LALITA N REYES FNP-C

Provider Business Mailing Address
First Line	:	341 HILLMAN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3329
Country	:	US
Telephone Number	:	917-324-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 HILLMAN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3329
Country	:	US
Telephone Number	:	917-324-0980
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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