Provider Demographics
NPI:1750636882
Name:BOYCE, GRACIELA (MSCED)
Entity Type:Individual
Prefix:MS
First Name:GRACIELA
Middle Name:
Last Name:BOYCE
Suffix:
Gender:F
Credentials:MSCED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11546 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2230
Mailing Address - Country:US
Mailing Address - Phone:718-744-8465
Mailing Address - Fax:
Practice Address - Street 1:11546 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2230
Practice Address - Country:US
Practice Address - Phone:718-744-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108963011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist