MEDICARE: ELIZABETH M MENDONCA

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	225XP0200X	Pediatric Occupational Therapist	P120673	NY

General Provider Information

NPI Number	:	1467154419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M MENDONCA

Provider Business Mailing Address
First Line	:	999 WILMOT RD
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-6899
Country	:	US
Telephone Number	:	914-725-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 OLD MAMARONECK RD
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-3717
Country	:	US
Telephone Number	:	914-725-7300
Fax Number	:

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

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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