Provider Demographics
NPI:1750721106
Name:MERCADO, GISSELLA
Entity type:Individual
Prefix:
First Name:GISSELLA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 FRASER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1908
Mailing Address - Country:US
Mailing Address - Phone:516-668-9115
Mailing Address - Fax:
Practice Address - Street 1:16216 UNION TPKE
Practice Address - Street 2:SUITE 303
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1958
Practice Address - Country:US
Practice Address - Phone:347-264-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency