MEDICARE: MRS. VICTORIA DAMICO CNP, RN

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	363LA2200X	Adult Health Nurse Practitioner	309609	NY

General Provider Information

NPI Number	:	1669142287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA DAMICO CNP, RN

Provider Business Mailing Address
First Line	:	492 RICHARD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3816
Country	:	US
Telephone Number	:	347-206-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 RICHARD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3816
Country	:	US
Telephone Number	:	347-206-4772
Fax Number	:

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	09/15/2021

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