Provider Demographics
NPI:1740535137
Name:FERNANDEZ, ALISON GRACE (MSED)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:GRACE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20980 18TH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1420
Mailing Address - Country:US
Mailing Address - Phone:347-256-6596
Mailing Address - Fax:
Practice Address - Street 1:20980 18TH AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1420
Practice Address - Country:US
Practice Address - Phone:347-256-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-21
Last Update Date:2012-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY854839174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator