Provider Demographics
NPI:1790168607
Name:CEBEDO, JUDITH LLENOS (NP-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LLENOS
Last Name:CEBEDO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:L
Other - Last Name:CEBEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:1517 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1176
Mailing Address - Country:US
Mailing Address - Phone:908-448-0828
Mailing Address - Fax:
Practice Address - Street 1:1517 FRONT ST
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1176
Practice Address - Country:US
Practice Address - Phone:908-448-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00546100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00546100OtherSTATE LICENSE