Provider Demographics
NPI:1235992173
Name:CORDERO, MYRA A (AGPCNP-BC, OCN)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:A
Last Name:CORDERO
Suffix:
Gender:F
Credentials:AGPCNP-BC, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PINEAPPLE ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6829
Mailing Address - Country:US
Mailing Address - Phone:718-249-6477
Mailing Address - Fax:
Practice Address - Street 1:45 PINEAPPLE ST APT 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6829
Practice Address - Country:US
Practice Address - Phone:212-610-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-571332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine