Provider Demographics
NPI:1740414366
Name:BROWN-GASKIN, CHERMAYNE VICTORIA
Entity Type:Individual
Prefix:
First Name:CHERMAYNE
Middle Name:VICTORIA
Last Name:BROWN-GASKIN
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 1:309 ALEXANDER AVE
Mailing Address - Street 2:4B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1172
Mailing Address - Country:US
Mailing Address - Phone:917-756-4868
Mailing Address - Fax:
Practice Address - Street 1:309 ALEXANDER AVE
Practice Address - Street 2:4B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1172
Practice Address - Country:US
Practice Address - Phone:917-756-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296416164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse