Provider Demographics
NPI:1164855300
Name:BREIHOF-MENDOZA, FELICIA ANN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:ANN
Last Name:BREIHOF-MENDOZA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 WHALEY ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4841
Mailing Address - Country:US
Mailing Address - Phone:516-507-4104
Mailing Address - Fax:
Practice Address - Street 1:16150 92ND ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3428
Practice Address - Country:US
Practice Address - Phone:718-848-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016598-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant