Provider Demographics
NPI:1205379054
Name:MERCEDES, ESTEFANIA
Entity Type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:MERCEDES
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 1:174 BEEKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-2444
Mailing Address - Country:US
Mailing Address - Phone:914-821-7555
Mailing Address - Fax:
Practice Address - Street 1:65 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4004
Practice Address - Country:US
Practice Address - Phone:914-751-0406
Practice Address - Fax:914-207-2286
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63021079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist