Provider Demographics
NPI:1952925745
Name:MENEZES, UTSMAI MARY (MD)
Entity type:Individual
Prefix:
First Name:UTSMAI
Middle Name:MARY
Last Name:MENEZES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9196
Mailing Address - Country:US
Mailing Address - Phone:212-562-2399
Mailing Address - Fax:718-334-5000
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-2399
Practice Address - Fax:718-334-5000
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2025-07-15
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-04-22
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY3287112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program