Healthcare Provider Details

I. General information

NPI: 1013347822
Provider Name (Legal Business Name): PAMELA BRAGLIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BROADWAY
AMITYVILLE NY
11701
US

IV. Provider business mailing address

333 BROADWAY
AMITYVILLE NY
11701-2719
US

V. Phone/Fax

Practice location:
  • Phone: 631-789-2020
  • Fax: 631-789-5669
Mailing address:
  • Phone: 316-789-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF-308806
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: