Provider Demographics
NPI:1114579737
Name:ROCHA DE ASSIS, GABRIELLE TAKINA (CPNP-AC/PC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:TAKINA
Last Name:ROCHA DE ASSIS
Suffix:
Gender:F
Credentials:CPNP-AC/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:OLIVEBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12461-5719
Mailing Address - Country:US
Mailing Address - Phone:845-514-6929
Mailing Address - Fax:
Practice Address - Street 1:43 NEW SCOTLAND AVE # MC-139
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3478
Practice Address - Country:US
Practice Address - Phone:518-262-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383025363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics