Individual
KATHERINE ROSANGELA QUEZADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
625 BELLE TERRE RD, PORT JEFFERSON, NY 11777-2316
(631) 473-1320
Mailing address
10 BISCAYNE DR, SELDEN, NY 11784-1011
(631) 481-5257
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
309278
NY
Other
Enumeration date
12/23/2019
Last updated
12/23/2019
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