Provider Demographics
NPI:1639444698
Name:DEMELO, BRENDA ANGELINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANGELINE
Last Name:DEMELO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:ANGELINE
Other - Last Name:KNESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4118 243RD ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1658
Mailing Address - Country:US
Mailing Address - Phone:718-225-1867
Mailing Address - Fax:
Practice Address - Street 1:3465 192ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1926
Practice Address - Country:US
Practice Address - Phone:718-886-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293375-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse