Individual
CANDACE CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
108963
NY
Other
Enumeration date
10/02/2015
Last updated
10/02/2015
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