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NPI Code Detail

MEDICARE: VONNAE CAMPBELL

MEDICARE: VONNAE CAMPBELL
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1982355459
Entity Type Code : Individual
Provider Name (Legal Business Name) : VONNAE CAMPBELL
Provider Business Mailing Address
First Line : 347 MANHATTAN AVE
Second Line :
City : WEST BABYLON
State : NY
Zip : 11704-5532
Country : US
Telephone Number : 631-332-5907
Fax Number :
Provider Business Practice Location Address
First Line : 347 MANHATTAN AVE
Second Line :
City : WEST BABYLON
State : NY
Zip : 11704-5532
Country : US
Telephone Number : 631-332-5907
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2022
Last Update Date : 01/15/2022

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Directions to “ VONNAE CAMPBELL ” Practice Location

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