Provider Demographics
NPI:1568196202
Name:CAMILO, BRENDA (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CAMILO
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MCLEAN AVE APT 3J
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4619
Mailing Address - Country:US
Mailing Address - Phone:718-650-9349
Mailing Address - Fax:
Practice Address - Street 1:122 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4706
Practice Address - Country:US
Practice Address - Phone:914-534-5987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF431982-01363LA2100X
NY714149163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse