Healthcare Provider Details

I. General information

NPI: 1730586132
Provider Name (Legal Business Name): MRS. ELENA CAUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MCWHORTER ST
BRENTWOOD NY
11717-3207
US

IV. Provider business mailing address

5 MCWHORTER ST
BRENTWOOD NY
11717-3207
US

V. Phone/Fax

Practice location:
  • Phone: 516-384-9204
  • Fax:
Mailing address:
  • Phone: 516-384-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number319943-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: