Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F-308806 | NY |
NPI | 1013347822 |
---|---|
Provider Name | Pamela Braglia |
First Address | Amityville, NY 11701-2719 |
Second Address | Amityville, NY 11701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2013 |
Last Update Date | 21/10/2019 |