Provider Demographics
NPI:1053551960
Name:DESTY, HAMELIE
Entity type:Individual
Prefix:
First Name:HAMELIE
Middle Name:
Last Name:DESTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 129TH ST
Mailing Address - Street 2:APT 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-1800
Mailing Address - Country:US
Mailing Address - Phone:646-320-3179
Mailing Address - Fax:
Practice Address - Street 1:300 W 129TH ST
Practice Address - Street 2:APT 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-1800
Practice Address - Country:US
Practice Address - Phone:646-320-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274966-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse