MEDICARE: LEONELY ALEXANDRA MERCADO MS, SLP

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	235Z00000X	Speech-Language Pathologist	024423	NY

General Provider Information

NPI Number	:	1619342789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONELY ALEXANDRA MERCADO MS, SLP

Provider Business Mailing Address
First Line	:	1574 40TH ST
Second Line	:	2F
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4436
Country	:	US
Telephone Number	:	917-804-2117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1574 40TH ST
Second Line	:	2F
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4436
Country	:	US
Telephone Number	:	917-804-2117
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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