Grace Shaji Mundackal, R.N

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

469185 Issued in NY

Practice address

482 Swanson Dr
Thornwood, NY 10594-2119

Phone

(914) 769-3591

NPI assigned

Jan 26, 2013

Sex

Female

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1359158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359158400000",
    "number": "1174861132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 SWANSON DR",
            "city": "THORNWOOD",
            "state": "NY",
            "postal_code": "105942119",
            "telephone_number": "914-769-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 SWANSON DR",
            "city": "THORNWOOD",
            "state": "NY",
            "postal_code": "105942119",
            "telephone_number": "914-769-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNDACKAL",
        "first_name": "GRACE",
        "middle_name": "SHAJI",
        "name_prefix": "Mrs.",
        "credential": "R.N",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-26",
        "last_updated": "2013-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "469185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Thornwood, NY
• Providers in Thornwood, 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 Jan 26, 2013; 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.