Provider Demographics
NPI:1033532908
Name:EUSSE, MAYRA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:EUSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 COLLEGE POINT BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1034
Mailing Address - Country:US
Mailing Address - Phone:646-894-9470
Mailing Address - Fax:
Practice Address - Street 1:8823 31ST AVE
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1437
Practice Address - Country:US
Practice Address - Phone:718-779-8800
Practice Address - Fax:718-779-2070
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator