Provider Demographics
NPI:1306676796
Name:TEJADA, ALBA ISABEL
Entity type:Individual
Prefix:MS
First Name:ALBA
Middle Name:ISABEL
Last Name:TEJADA
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 1:2301 BOSCOBEL LOOP
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-7140
Mailing Address - Country:US
Mailing Address - Phone:646-417-2703
Mailing Address - Fax:
Practice Address - Street 1:2301 BOSCOBEL LOOP
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-7140
Practice Address - Country:US
Practice Address - Phone:646-417-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse