Provider Demographics
NPI:1467696658
Name:NUNEZ, FREDDY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FREDDY
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S 3RD ST APT A2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-6347
Mailing Address - Country:US
Mailing Address - Phone:347-451-6727
Mailing Address - Fax:
Practice Address - Street 1:8 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8722
Practice Address - Country:US
Practice Address - Phone:631-665-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013116363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical