Provider Demographics
NPI:1710956545
Name:RICHARDS LEE, ARLENE DIANTHE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ARLENE
Middle Name:DIANTHE
Last Name:RICHARDS LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:DIANTHE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:43 PAERDEGAT 5 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-241-1815
Mailing Address - Fax:
Practice Address - Street 1:2304 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3115
Practice Address - Country:US
Practice Address - Phone:757-951-1579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010425-1363A00000X
VA0110004986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant