Provider Demographics
NPI:1740562032
Name:SEGURA, ARYCELIS DIANE (MA, CHES, CLC, CDE)
Entity Type:Individual
Prefix:MS
First Name:ARYCELIS
Middle Name:DIANE
Last Name:SEGURA
Suffix:
Gender:F
Credentials:MA, CHES, CLC, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 GRAND CONCOURSE
Mailing Address - Street 2:AREA A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4902
Mailing Address - Country:US
Mailing Address - Phone:718-960-1526
Mailing Address - Fax:718-960-2176
Practice Address - Street 1:2532 GRAND CONCOURSE
Practice Address - Street 2:AREA A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4902
Practice Address - Country:US
Practice Address - Phone:718-960-1526
Practice Address - Fax:718-960-2176
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21650174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator