Provider Demographics
NPI:1255899654
Name:AUDAIN, PHILLICIA
Entity type:Individual
Prefix:
First Name:PHILLICIA
Middle Name:
Last Name:AUDAIN
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 1:18 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2728
Mailing Address - Country:US
Mailing Address - Phone:516-467-7855
Mailing Address - Fax:
Practice Address - Street 1:18 CEDAR RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2728
Practice Address - Country:US
Practice Address - Phone:516-467-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse