Provider Demographics
NPI:1356006456
Name:MECHERIL, LAICY GEORGE (NP)
Entity Type:Individual
Prefix:
First Name:LAICY
Middle Name:GEORGE
Last Name:MECHERIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WAYLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1120
Mailing Address - Country:US
Mailing Address - Phone:574-974-7078
Mailing Address - Fax:
Practice Address - Street 1:1 WAYLAND RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1120
Practice Address - Country:US
Practice Address - Phone:516-974-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310354363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health