Healthcare Provider Details

I. General information

NPI: 1376101790
Provider Name (Legal Business Name): TENIKA FILOMENA WALTERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 HAMILTON AVE
MONTICELLO NY
12701-1378
US

IV. Provider business mailing address

26 HAMILTON AVE STE 2
MONTICELLO NY
12701-1378
US

V. Phone/Fax

Practice location:
  • Phone: 845-397-7101
  • Fax: 845-428-7815
Mailing address:
  • Phone: 845-397-7101
  • Fax: 845-428-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN54434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: