Jose Antonio Sepulveda Jr., REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

777879-01 Issued in NY

Practice address

15 Fortune Rd
West Middletown, NY 10941

Phone

(845) 692-4454

NPI assigned

Oct 9, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1013559244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 HIGHLAND AVE",
            "city": "WALDEN",
            "state": "NY",
            "postal_code": "125861034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 FORTUNE RD",
            "city": "WEST MIDDLETOWN",
            "state": "NY",
            "postal_code": "10941",
            "telephone_number": "845-692-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEPULVEDA",
        "first_name": "JOSE",
        "middle_name": "ANTONIO",
        "name_suffix": "Jr.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "777879-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Yvette McDole, LMSW
• Latasha Fiona Murray
• William Edward Patterson Jr.
• Kristy Rivera, LMSW
• Kayla Marie Savely, MHC-LP
• Brooke Kathleen Smith, LMSW
• Sonie Williams, LMSW

• Registered Nurse in West Middletown, NY
• Providers in West Middletown, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.