Healthcare Provider Details

I. General information

NPI: 1760272405
Provider Name (Legal Business Name): DEANDRIENNE VICTORIA GREGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E 147TH ST FL 1
BRONX NY
10455-4104
US

IV. Provider business mailing address

219 KINGSBOROUGH 2ND WALK APT 3B
BROOKLYN NY
11233-3628
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6708
  • Fax:
Mailing address:
  • Phone: 718-200-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number972711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: