Healthcare Provider Details

I. General information

NPI: 1730960295
Provider Name (Legal Business Name): DEVONAIRE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OLD ROUTE 6
CARMEL NY
10512-2107
US

IV. Provider business mailing address

233 GARDEN ST
NEW WINDSOR NY
12553-7313
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-5202
  • Fax: 845-225-0700
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number620320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: