Healthcare Provider Details

I. General information

NPI: 1669864443
Provider Name (Legal Business Name): ANLLY CAMILO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

85 BARTLETT ST
BROOKLYN NY
11206-4429
US

IV. Provider business mailing address

908 E 181ST ST APT 5K
BRONX NY
10460-1933
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: