Provider Demographics
NPI:1346960754
Name:DELGADO, MERCEDES VIRGINIA (LAC)
Entity Type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:VIRGINIA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22215 NORTHERN BLVD STE C6
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3678
Mailing Address - Country:US
Mailing Address - Phone:718-489-4028
Mailing Address - Fax:
Practice Address - Street 1:22215 NORTHERN BLVD STE C6
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3678
Practice Address - Country:US
Practice Address - Phone:718-489-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist