Provider Demographics
NPI:1760002323
Name:TYRELL, SATCHELL-LEE (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:SATCHELL-LEE
Middle Name:
Last Name:TYRELL
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5520
Mailing Address - Country:US
Mailing Address - Phone:347-279-3300
Mailing Address - Fax:
Practice Address - Street 1:537 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5445
Practice Address - Country:US
Practice Address - Phone:347-279-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309626363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health