Provider Demographics
NPI:1487395679
Name:DROSS, MAYRA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:DROSS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:ALI-DROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:91 COCOANUT ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7201
Mailing Address - Country:US
Mailing Address - Phone:631-575-9261
Mailing Address - Fax:
Practice Address - Street 1:91 COCOANUT ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7201
Practice Address - Country:US
Practice Address - Phone:631-575-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321175-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty