Individual provider Active NPI

Angela Grace De Mesa Burnos

  • Family Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1114866803
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
355904 Issued in NY
Practice address
1825 Boston Rd
Bronx, NY 10460-4996
Phone
(718) 842-8040
NPI assigned
Mar 26, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 355904 NY Primary

Addresses

Primary practice location

1825 Boston Rd
Bronx, NY 10460-4996

Mailing address

600 E 233Rd St Ste 5N
Bronx, NY 10466-2604
Phone (718) 920-9536

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260421002558 NY Practitioner - Nurse Practitioner 2961978473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

100 Corporate Dr
Yonkers, NY 10701-6807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
355904NYMDFamily Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1774483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1114866803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E 233RD ST STE 5N",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104662604",
            "telephone_number": "718-920-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 BOSTON RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104604996",
            "telephone_number": "718-842-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNOS",
        "first_name": "ANGELA GRACE",
        "middle_name": "DE MESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-03-26",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "355904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.