Healthcare Provider Details

I. General information

NPI: 1497669691
Provider Name (Legal Business Name): CAMERON LEON GHYLL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7102 WATERS VIEW CIR # 7102
COHOES NY
12047-5216
US

IV. Provider business mailing address

7102 WATERS VIEW CIR # 7102
COHOES NY
12047-5216
US

V. Phone/Fax

Practice location:
  • Phone: 917-807-8196
  • Fax:
Mailing address:
  • Phone: 917-807-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number330033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: