Provider Demographics
NPI:1538454038
Name:MINEIRO, CARLOS H
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:H
Last Name:MINEIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 SHELTER RD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4845
Mailing Address - Country:US
Mailing Address - Phone:631-676-2109
Mailing Address - Fax:
Practice Address - Street 1:224 SHELTER RD
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4845
Practice Address - Country:US
Practice Address - Phone:631-676-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297374-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse