Individual
CHARISE YVONNE GUADARRAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
93-19 ROOSEVELT AVENUE, JACKSON HEIGHTS, NY 11372
(718) 803-8463
(718) 803-8465
Mailing address
131 MALTS AVE, WEST ISLIP, NY 11795-2509
(631) 888-3771
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011162
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02850219
—
NY
Enumeration date
07/17/2006
Last updated
06/04/2008
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