Provider Demographics
NPI:1902281314
Name:MENDOZA, JANELLE AILEEN (MS, AGPCNP-BC, ACHPN)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:AILEEN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS, AGPCNP-BC, ACHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 BROOME ST
Mailing Address - Street 2:APT. 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4533
Mailing Address - Country:US
Mailing Address - Phone:347-601-3401
Mailing Address - Fax:
Practice Address - Street 1:261 BROOME ST
Practice Address - Street 2:APT. 6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4533
Practice Address - Country:US
Practice Address - Phone:347-601-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY617453-1163W00000X
NYF307122-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse