Provider Demographics
NPI:1558617696
Name:NEBO, TYPHANIE LYNN (PA-C)
Entity Type:Individual
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First Name:TYPHANIE
Middle Name:LYNN
Last Name:NEBO
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:2 W FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5359
Practice Address - Country:US
Practice Address - Phone:914-219-0156
Practice Address - Fax:914-219-0159
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2019-02-20
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Provider Licenses
StateLicense IDTaxonomies
NY015804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant