Provider Demographics
NPI:1730419300
Name:ESTRELLA, LISSETTE (ANP, PNP)
Entity type:Individual
Prefix:MS
First Name:LISSETTE
Middle Name:
Last Name:ESTRELLA
Suffix:
Gender:F
Credentials:ANP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL # 1497
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-241-6947
Mailing Address - Fax:
Practice Address - Street 1:ONE GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1497
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-7055
Practice Address - Fax:212-860-3316
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303838-1363LA2200X
NYF381035-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02339935Medicaid
1730419300OtherNPI
NY02339935Medicaid
NYP87828Medicare UPIN