Healthcare Provider Details

I. General information

NPI: 1982143038
Provider Name (Legal Business Name): VINCENT M GUILAMO RN, NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2325
US

IV. Provider business mailing address

29 WASHINGTON SQ W APT 7D
NEW YORK NY
10011-9132
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4000
  • Fax:
Mailing address:
  • Phone: 917-565-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: