Provider Demographics
NPI:1356856678
Name:AWANYAI, MERCILLINA
Entity Type:Individual
Prefix:
First Name:MERCILLINA
Middle Name:
Last Name:AWANYAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IYAHO SOCIAL SERVICES
Mailing Address - Street 2:208 13 JAMAICA AVENUE
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:IYAHO SOCIAL SERVICES. 71 N FRANKLIN ST
Practice Address - Street 2:#211
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3048
Practice Address - Country:US
Practice Address - Phone:516-280-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator