Provider Demographics
NPI:1972942225
Name:VELASQUEZ, MYRA LINDA (RN)
Entity type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:LINDA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2305
Mailing Address - Country:US
Mailing Address - Phone:646-894-2550
Mailing Address - Fax:
Practice Address - Street 1:853 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2305
Practice Address - Country:US
Practice Address - Phone:646-894-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342064163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse