Provider Demographics
NPI:1619464492
Name:MERCADO, MONIQUE ROBYN (NP)
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:ROBYN
Last Name:MERCADO
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 1:300 SKILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1607
Mailing Address - Country:US
Mailing Address - Phone:718-200-0271
Mailing Address - Fax:
Practice Address - Street 1:240 E 38TH ST # 15-32
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2708
Practice Address - Country:US
Practice Address - Phone:212-263-6037
Practice Address - Fax:646-501-7775
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily