Provider Demographics
NPI:1720237621
Name:TRADER-CAMPASANO, BELYNDA CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:BELYNDA
Middle Name:CHRISTINE
Last Name:TRADER-CAMPASANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BELYNDA
Other - Middle Name:CHRISTINE
Other - Last Name:TRADER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:656 WELLWOOD AVE STE G&H
Mailing Address - Street 2:PREMIER CARE
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1695
Mailing Address - Country:US
Mailing Address - Phone:631-225-4227
Mailing Address - Fax:
Practice Address - Street 1:656 WELLWOOD AVE STE G&H
Practice Address - Street 2:PREMIER CARE
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1695
Practice Address - Country:US
Practice Address - Phone:631-225-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant