Individual provider Active NPI

Mary Daphne Mondejar, NP

  • Nurse Practitioner
  • New York, NY
National Provider Identifier
1235028473
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
312324 Issued in NY
Practice address
930 Saint Nicholas Ave Apt 46
New York, NY 10032-5229
Phone
(917) 515-2352
NPI assigned
Jul 1, 2025
Last updated
Jul 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 312324 NY Primary

Addresses

Primary practice location

930 Saint Nicholas Ave Apt 46
New York, NY 10032-5229

Mailing address

930 Saint Nicholas Ave Apt 46
New York, NY 10032-5229
Phone (917) 515-2352

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
I20250924001725 NY Order and Referring Only - Nurse Practitioner 3971008665

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

New York, NY 10032
Phone (917) 515-2352

516 Pennsfield PL
Suite 214
Thousand Oaks, CA 91360-5500

930 Saint Nicholas Ave
Apt 46
New York, NY 10032-5229

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1235028473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 SAINT NICHOLAS AVE APT 46",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100325229",
            "telephone_number": "917-515-2352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 SAINT NICHOLAS AVE APT 46",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100325229",
            "telephone_number": "917-515-2352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONDEJAR",
        "first_name": "MARY DAPHNE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "312324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.