Provider Demographics
NPI:1457401952
Name:MENARDY, FLORE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:FLORE MARIE
Middle Name:
Last Name:MENARDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 BURLINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-5011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:476 BURLINGHAM ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:NY
Practice Address - Zip Code:12721
Practice Address - Country:US
Practice Address - Phone:917-744-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF40029363LP0808X
NYF400929363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02916645Medicaid
NYA300033058Medicare UPIN