MEDICARE: ANNIE DEPAOLO NP

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
1	363LF0000X	Family Nurse Practitioner	F355415	NY

General Provider Information

NPI Number	:	1255157822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE DEPAOLO NP

Provider Business Mailing Address
First Line	:	1295 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2973
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2973
Country	:	US
Telephone Number	:	718-682-3903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2024
Last Update Date	:	11/28/2024

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