Healthcare Provider Details

I. General information

NPI: 1811814429
Provider Name (Legal Business Name): NADINE GHRANWI TAMILO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SUFFERN PL STE A
SUFFERN NY
10901-5566
US

IV. Provider business mailing address

22 MONTGOMERY ST APT 6C
POUGHKEEPSIE NY
12601-4020
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax: 845-357-5039
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number343544-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: