Healthcare Provider Details

I. General information

NPI: 1285504720
Provider Name (Legal Business Name): ANNABELLE CARLA ANTOINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S 27TH ST
WYANDANCH NY
11798-2807
US

IV. Provider business mailing address

67 S 27TH ST
WYANDANCH NY
11798-2807
US

V. Phone/Fax

Practice location:
  • Phone: 631-264-4282
  • Fax:
Mailing address:
  • Phone: 631-264-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number918904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: