Provider Demographics
NPI:1427486661
Name:CALERO, AUDREY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:CALERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:CALERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3198 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1000
Mailing Address - Country:US
Mailing Address - Phone:718-618-0401
Mailing Address - Fax:718-795-4394
Practice Address - Street 1:1550 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1503
Practice Address - Country:US
Practice Address - Phone:646-350-1616
Practice Address - Fax:646-419-4487
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant