Provider Demographics
NPI:1568724730
Name:DJEGNON, AMELE
Entity Type:Individual
Prefix:
First Name:AMELE
Middle Name:
Last Name:DJEGNON
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 1:16347 130TH AVE
Mailing Address - Street 2:APT 11G
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3081
Mailing Address - Country:US
Mailing Address - Phone:718-801-9589
Mailing Address - Fax:
Practice Address - Street 1:16347 130TH AVE
Practice Address - Street 2:APT 11G
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3081
Practice Address - Country:US
Practice Address - Phone:718-801-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656154163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse