Healthcare Provider Details

I. General information

NPI: 1609511146
Provider Name (Legal Business Name): AKIMA S ELLIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

IV. Provider business mailing address

154 3RD AVE APT E
ALBANY NY
12202-1457
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6000
  • Fax:
Mailing address:
  • Phone: 518-423-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number807999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: