MEDICARE: DR. MARCELA TREVINO DO, MSHS, MBS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1801695846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELA TREVINO DO, MSHS, MBS

Provider Business Mailing Address
First Line	:	624 MCCLELLAN ST STE 101
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-1020
Country	:	US
Telephone Number	:	518-347-5043
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 MCCLELLAN ST STE 101
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-1020
Country	:	US
Telephone Number	:	518-347-5043
Fax Number	:

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

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	05/06/2026

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