MEDICARE: DONNA MAE MENDOZA PEREZ

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	225200000X	Physical Therapy Assistant	013805-01	NY

General Provider Information

NPI Number	:	1942157995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MAE MENDOZA PEREZ

Provider Business Mailing Address
First Line	:	7 OCALA CT
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-3741
Country	:	US
Telephone Number	:	631-448-2361
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 E MAIN ST
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2840
Country	:	US
Telephone Number	:	631-880-7577
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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