Provider Demographics
NPI:1821621301
Name:RILEY, DONNET ANDREA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNET
Middle Name:ANDREA
Last Name:RILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 PALMER RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3309
Mailing Address - Country:US
Mailing Address - Phone:772-475-1348
Mailing Address - Fax:
Practice Address - Street 1:781 PALMER RD APT 3A
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3309
Practice Address - Country:US
Practice Address - Phone:772-475-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345155-01208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice