Healthcare Provider Details

I. General information

NPI: 1396130258
Provider Name (Legal Business Name): ELIZABETH SCANTLEBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N ELLIOTT PL APT 12H
BROOKLYN NY
11205-1051
US

IV. Provider business mailing address

45 N ELLIOTT PL APT 12H
BROOKLYN NY
11205-1051
US

V. Phone/Fax

Practice location:
  • Phone: 347-200-6495
  • Fax:
Mailing address:
  • Phone: 347-200-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number696677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: