Provider Demographics
NPI:1609426105
Name:AMY, ANAELLE (RN)
Entity Type:Individual
Prefix:
First Name:ANAELLE
Middle Name:
Last Name:AMY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CRANBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4922
Mailing Address - Country:US
Mailing Address - Phone:718-200-5983
Mailing Address - Fax:
Practice Address - Street 1:40 CRANBERRY ST
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4922
Practice Address - Country:US
Practice Address - Phone:718-200-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY775690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse