Healthcare Provider Details

I. General information

NPI: 1356861918
Provider Name (Legal Business Name): BRIELLE CAMILLE GRECO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S BAY RD STE 1
DOVER DE
19901-4615
US

IV. Provider business mailing address

640 S STATE ST, POB 3RD FLOOR
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-730-4366
  • Fax: 302-730-0231
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: