Provider Demographics
NPI:1619521580
Name:CAMBA, ERICA DEVONNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DEVONNE
Last Name:CAMBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ROBERT PITT DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3333
Mailing Address - Country:US
Mailing Address - Phone:845-352-6800
Mailing Address - Fax:347-479-1303
Practice Address - Street 1:40 ROBERT PITT DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3333
Practice Address - Country:US
Practice Address - Phone:845-352-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05773175Medicaid