Provider Demographics
NPI:1245771153
Name:MEDINA-MERCADO, SUHEIDI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUHEIDI
Middle Name:
Last Name:MEDINA-MERCADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 CALLE ATIENZA
Mailing Address - Street 2:URB PASEOS REALES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:US
Mailing Address - Phone:787-449-4128
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE LUIS MOLINA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-3449
Practice Address - Country:US
Practice Address - Phone:787-449-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical