MEDICARE: CLEEVON C MERCURIUS

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	163WR0006X	Registered Nurse First Assistant	930180-01	NY

General Provider Information

NPI Number	:	1902763105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEEVON C MERCURIUS

Provider Business Mailing Address
First Line	:	322 BIRCH RD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-1104
Country	:	US
Telephone Number	:	914-258-2618
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 BIRCH RD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-1104
Country	:	US
Telephone Number	:	914-258-2618
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ CLEEVON C MERCURIUS ” Practice Location

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