Provider Demographics
NPI:1598006660
Name:CLANCY, PHELAN ANTONIA (ANP)
Entity Type:Individual
Prefix:MS
First Name:PHELAN
Middle Name:ANTONIA
Last Name:CLANCY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-4012
Mailing Address - Country:US
Mailing Address - Phone:718-220-0439
Mailing Address - Fax:718-933-2914
Practice Address - Street 1:2336 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-6903
Practice Address - Country:US
Practice Address - Phone:718-220-0439
Practice Address - Fax:718-933-2914
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6573601163W00000X
NY306844-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse