Provider Demographics
NPI:1225729551
Name:BRANCACCIO DOODY, CELEEN MARY
Entity Type:Individual
Prefix:
First Name:CELEEN
Middle Name:MARY
Last Name:BRANCACCIO DOODY
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 1:66 STEBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3829
Mailing Address - Country:US
Mailing Address - Phone:914-202-7054
Mailing Address - Fax:
Practice Address - Street 1:66 STEBBINS AVE
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-3829
Practice Address - Country:US
Practice Address - Phone:914-202-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY512380163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool