Provider Demographics
NPI:1851817324
Name:PERSAUD, ADELINE YVETTE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ADELINE
Middle Name:YVETTE
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CAMPBELL BLVD UNIT 7301
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-6220
Mailing Address - Country:US
Mailing Address - Phone:908-783-7322
Mailing Address - Fax:
Practice Address - Street 1:101 CAMPBELL BLVD UNIT 7301
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-6220
Practice Address - Country:US
Practice Address - Phone:908-783-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00743000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine