Provider Demographics
NPI:1942371133
Name:CUEVO, LYDIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:CUEVO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 QUARRY DR
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-2003
Mailing Address - Country:US
Mailing Address - Phone:914-302-6230
Mailing Address - Fax:
Practice Address - Street 1:1345 QUARRY DR
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-2003
Practice Address - Country:US
Practice Address - Phone:914-302-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY364382-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY364382-1OtherPROFESSIONAL LICENSE NUMB
NY01692319Medicaid