Healthcare Provider Details

I. General information

NPI: 1588113161
Provider Name (Legal Business Name): CLAYDEAN ANTOINETTE TOWNSEND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2016
Last Update Date: 09/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 LEXINGTON WAY
MIDDLETOWN NY
10940-1607
US

IV. Provider business mailing address

59 LEXINGTON WAY
MIDDLETOWN NY
10940-1607
US

V. Phone/Fax

Practice location:
  • Phone: 347-260-2306
  • Fax:
Mailing address:
  • Phone: 347-260-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number642036-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number642036-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number642036-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number642036-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: