Organization
BREONA PETTEWAY SUPPORT SERVICES INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BREONA PETTEWAY (LPN)
(934) 256-2441
Entity
Organization
Contact information
Practice address
18 LAKE DR, WYANDANCH, NY 11798-3430
(934) 256-2441
(934) 256-2441
Mailing address
54 STATE ST STE 80416264, ALBANY, NY 12207-2540
(934) 256-2441
(934) 256-2441
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
Other
Enumeration date
01/27/2026
Last updated
01/27/2026
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