Provider Demographics
NPI:1649769167
Name:DAMATO, PAMELA ANN X (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:DAMATO
Suffix:X
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 1:744 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2806
Mailing Address - Country:US
Mailing Address - Phone:347-537-8593
Mailing Address - Fax:
Practice Address - Street 1:744 W BEECH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2806
Practice Address - Country:US
Practice Address - Phone:347-537-8593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty