Provider Demographics
NPI:1619643137
Name:SCIBELLI, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SCIBELLI
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 1:6407 PETERS LN
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-9329
Mailing Address - Country:US
Mailing Address - Phone:518-669-1972
Mailing Address - Fax:
Practice Address - Street 1:125 HARRY HOWARD AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1601
Practice Address - Country:US
Practice Address - Phone:518-828-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002410-01208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation