Provider Demographics
NPI:1316743529
Name:MERCADO, KEYSHLA
Entity type:Individual
Prefix:
First Name:KEYSHLA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:939-266-6834
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 71474
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-8574
Practice Address - Country:US
Practice Address - Phone:939-266-6834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR100906364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty