Individual
ANGELA DEBRODT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RN, AGNP-C
Contact information
Practice address
2500 NESCONSET HWY, STONY BROOK, NY 11790-2555
(631) 364-9038
Mailing address
2500 NESCONSET HWY, STONY BROOK, NY 11790-2555
(631) 364-9038
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
619575
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
310063-01
NY
363LG0600X
Gerontology Nurse Practitioner
310063-01
NY
Other
Enumeration date
01/11/2017
Last updated
02/11/2025
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