Healthcare Provider Details

I. General information

NPI: 1346538055
Provider Name (Legal Business Name): MICHELE CILLO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ROSE AVE
STATEN ISLAND NY
10306-2241
US

IV. Provider business mailing address

130 ROSE AVENUE
STATEN ISLAND NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-1553
  • Fax:
Mailing address:
  • Phone: 718-980-1553
  • Fax: 718-727-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberF336660
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: