Individual
ANGELINE WENDY BOODOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13 CLEVELAND ST, VALLEY STREAM, NY 11580-6003
(516) 823-0739
Mailing address
13 CLEVELAND STREET, VALLEY STREAM, NY 11580
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
669992-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
669992-1
REGISTERED NURSE
NY
Enumeration date
02/16/2015
Last updated
02/16/2015
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