Provider Demographics
NPI:1265563795
Name:AGOSTO, MYRNA (NPP)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13340 132ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3807
Mailing Address - Country:US
Mailing Address - Phone:718-322-1747
Mailing Address - Fax:718-565-8392
Practice Address - Street 1:7520 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1131
Practice Address - Country:US
Practice Address - Phone:718-888-6788
Practice Address - Fax:718-565-8302
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400605163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult