Active NPI
Stacy De Jesus
- Registered Nurse
- Bronx, NY
National Provider Identifier
1407719693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 876405-01
- Practice address
- 990 Bronx Park S Apt 310
Bronx, NY 10460-1613 - Phone
- (917) 331-3414
- NPI assigned
- Dec 4, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 876405-01 | NY | Primary |
Addresses
Primary practice location
990 Bronx Park S Apt 310
Bronx, NY 10460-1613
Mailing address
990 Bronx Park S Apt 310
Bronx, NY 10460-1613
Phone (917) 331-3414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 876405-01 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1764806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764806400000",
"number": "1407719693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "990 BRONX PARK S APT 310",
"city": "BRONX",
"state": "NY",
"postal_code": "104601613",
"telephone_number": "917-331-3414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 BRONX PARK S APT 310",
"city": "BRONX",
"state": "NY",
"postal_code": "104601613",
"telephone_number": "917-331-3414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE JESUS",
"first_name": "STACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-12-04",
"last_updated": "2025-12-04",
"certification_date": "2025-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "876405-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.