Provider Demographics
NPI:1578745360
Name:MARCELLUS, GUIRLANDE
Entity Type:Individual
Prefix:MS
First Name:GUIRLANDE
Middle Name:
Last Name:MARCELLUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GUIRLANDE
Other - Middle Name:MARCELLUS
Other - Last Name:VALMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1315 E 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4403
Mailing Address - Country:US
Mailing Address - Phone:718-968-9240
Mailing Address - Fax:
Practice Address - Street 1:1315 E 98TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4403
Practice Address - Country:US
Practice Address - Phone:718-968-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248487-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02492542Medicaid