Provider Demographics
NPI:1609518323
Name:PEREZ, JANYLL A (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JANYLL
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2918
Mailing Address - Country:US
Mailing Address - Phone:914-294-8846
Mailing Address - Fax:
Practice Address - Street 1:417 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2918
Practice Address - Country:US
Practice Address - Phone:914-294-8846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719763163W00000X
NYL-303487163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYL-303487OtherIBCLC CERTIFICATION
NY719763OtherRN LICENSE