Provider Demographics
NPI:1770243867
Name:FERNANDES, GISELLE CATHERINE
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:CATHERINE
Last Name:FERNANDES
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 1:215 W 95TH ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6340
Mailing Address - Country:US
Mailing Address - Phone:732-567-2420
Mailing Address - Fax:
Practice Address - Street 1:215 W 95TH ST APT 3L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6340
Practice Address - Country:US
Practice Address - Phone:732-567-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program