Healthcare Provider Details

I. General information

NPI: 1952277907
Provider Name (Legal Business Name): THOMAS T CANNELL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MARLBOROUGH RD
BROOKLYN NY
11226-4510
US

IV. Provider business mailing address

214 MARLBOROUGH RD
BROOKLYN NY
11226-4510
US

V. Phone/Fax

Practice location:
  • Phone: 301-943-2756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number759021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: