MEDICARE: FINELA DAEDRE PUA CABANDING PT

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	049405	NY

General Provider Information

NPI Number	:	1619717394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FINELA DAEDRE PUA CABANDING PT

Provider Business Mailing Address
First Line	:	22809 64TH AVE FL 1
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22809 64TH AVE FL 1
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2410
Country	:	US
Telephone Number	:	914-496-7700
Fax Number	:

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

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/08/2026

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