Healthcare Provider Details

I. General information

NPI: 1780872861
Provider Name (Legal Business Name): RHONDA DEGANNES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2007
Last Update Date: 10/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2832
US

IV. Provider business mailing address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2832
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6808
  • Fax:
Mailing address:
  • Phone: 718-206-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000854
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: