Provider Demographics
NPI:1326019878
Name:MERRELL, DESIREE (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:MERRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 216TH ST
Mailing Address - Street 2:ST. MARY'S HOSPITAL FOR CHILDREN
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2810
Mailing Address - Country:US
Mailing Address - Phone:718-281-8569
Mailing Address - Fax:718-281-8590
Practice Address - Street 1:2901 216TH ST
Practice Address - Street 2:ST. MARY'S HOSPITAL FOR CHILDREN
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2810
Practice Address - Country:US
Practice Address - Phone:718-281-8569
Practice Address - Fax:718-281-8590
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1747822080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine