Provider Demographics
NPI:1588677983
Name:CERASUOLO, ESTRELLA TEJADA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ESTRELLA
Middle Name:TEJADA
Last Name:CERASUOLO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:ESTRELLA
Other - Middle Name:CALIWARA
Other - Last Name:TEJADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CRNA
Mailing Address - Street 1:4 BOBOLINK PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-5367
Mailing Address - Country:US
Mailing Address - Phone:914-968-8455
Mailing Address - Fax:914-968-1588
Practice Address - Street 1:150 55TH ST
Practice Address - Street 2:LUTHERAN MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2559
Practice Address - Country:US
Practice Address - Phone:718-630-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228835-1163W00000X
IL023580367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse