Provider Demographics
NPI:1497879241
Name:DESLANDES, ELMO FERREIRA (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ELMO
Middle Name:FERREIRA
Last Name:DESLANDES
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 1:3965 SEDGWICK AVE APT 7C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3139
Mailing Address - Country:US
Mailing Address - Phone:718-548-0219
Mailing Address - Fax:
Practice Address - Street 1:3965 SEDGWICK AVE APT 7C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3139
Practice Address - Country:US
Practice Address - Phone:718-548-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006720-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant