Provider Demographics
NPI:1891041638
Name:TEJERA, CANDY (MA, MSED)
Entity Type:Individual
Prefix:MISS
First Name:CANDY
Middle Name:
Last Name:TEJERA
Suffix:
Gender:F
Credentials:MA, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 160TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3824
Mailing Address - Country:US
Mailing Address - Phone:718-702-9083
Mailing Address - Fax:
Practice Address - Street 1:1819 160TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3824
Practice Address - Country:US
Practice Address - Phone:718-702-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1797252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist