Organization
ANGEL MIRACLE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAKIERA SIMONE BRYANT (OWNER)
(516) 265-6525
Entity
Organization
Contact information
Practice address
621 VANDERBILT LOOP, YAPHANK, NY 11980-2051
(516) 265-6525
Mailing address
621 VANDERBILT LOOP, YAPHANK, NY 11980-2051
(516) 265-6525
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205129103
—
NY
Enumeration date
04/16/2024
Last updated
09/11/2025
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