Provider Demographics
NPI:1639769458
Name:ACHA, FERDELYN GRACE
Entity Type:Individual
Prefix:
First Name:FERDELYN GRACE
Middle Name:
Last Name:ACHA
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 1:2312 7TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1910
Mailing Address - Country:US
Mailing Address - Phone:201-647-4086
Mailing Address - Fax:
Practice Address - Street 1:2312 7TH ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1910
Practice Address - Country:US
Practice Address - Phone:201-647-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00960-1314000000X
NY009691-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility