Provider Demographics
NPI:1831489525
Name:RHODES, ANNABELLE MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANNABELLE
Middle Name:MARIE
Last Name:RHODES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ANABEL
Other - Middle Name:
Other - Last Name:OBREGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 ARISTA CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4908
Mailing Address - Country:US
Mailing Address - Phone:631-327-5572
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4870
Practice Address - Country:US
Practice Address - Phone:631-654-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014718-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant