Provider Demographics
NPI:1790107043
Name:SEGURA, ESMELDY
Entity Type:Individual
Prefix:MRS
First Name:ESMELDY
Middle Name:
Last Name:SEGURA
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 1:286 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4639
Mailing Address - Country:US
Mailing Address - Phone:315-733-2227
Mailing Address - Fax:315-733-0804
Practice Address - Street 1:286 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4639
Practice Address - Country:US
Practice Address - Phone:315-733-2227
Practice Address - Fax:315-733-0804
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423148393172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver