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NPI Code Detail

MEDICARE: MRS. CAMILLE H SMALL-DESHIELDS

MEDICARE: MRS. CAMILLE H SMALL-DESHIELDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist039680NY

General Provider Information

NPI Number : 1053683284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAMILLE H SMALL-DESHIELDS
Provider Business Mailing Address
First Line : 1928 SUNSET PL
Second Line :
City : SCOTCH PLAINS
State : NJ
Zip : 07076-1207
Country : US
Telephone Number : 908-322-6430
Fax Number : 908-288-7141
Provider Business Practice Location Address
First Line : 454 5TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11215-4003
Country : US
Telephone Number : 718-768-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2012
Last Update Date : 04/30/2025

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