Healthcare Provider Details

I. General information

NPI: 1124729454
Provider Name (Legal Business Name): ANGIE CLAIRVIL SENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 W BROAD AVE
ALBANY GA
31707-4124
US

IV. Provider business mailing address

2021 W BROAD AVE
ALBANY GA
31707-4124
US

V. Phone/Fax

Practice location:
  • Phone: 516-343-4734
  • Fax:
Mailing address:
  • Phone: 516-343-4734
  • Fax: 516-343-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: