Provider Demographics
NPI:1629396593
Name:DAMAS, ERICA (LPN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DAMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 MANATUCK BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1557
Mailing Address - Country:US
Mailing Address - Phone:631-813-3473
Mailing Address - Fax:631-245-6639
Practice Address - Street 1:1684 MANATUCK BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1557
Practice Address - Country:US
Practice Address - Phone:631-813-3473
Practice Address - Fax:631-245-6639
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301047-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse