Provider Demographics
NPI:1225491509
Name:CAMILLE, SORAYA
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:CAMILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 AVENUE O
Mailing Address - Street 2:APT 6E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5244
Mailing Address - Country:US
Mailing Address - Phone:646-542-3916
Mailing Address - Fax:
Practice Address - Street 1:2607 AVENUE O
Practice Address - Street 2:APT 6E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5244
Practice Address - Country:US
Practice Address - Phone:646-542-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse