Provider Demographics
NPI:1518317437
Name:MERCADO, KATHY (TRANSPORTATION)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 ROUNDHILL DR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2413
Mailing Address - Country:US
Mailing Address - Phone:347-744-0840
Mailing Address - Fax:646-386-7217
Practice Address - Street 1:81 ROUNDHILL DR
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2413
Practice Address - Country:US
Practice Address - Phone:347-744-0840
Practice Address - Fax:646-386-7217
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671875995172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver