Provider Demographics
NPI:1679936595
Name:RENDA, BRIANNA MICHELLE (ANP)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:MICHELLE
Last Name:RENDA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:BRIANNA
Other - Middle Name:MICHELLE
Other - Last Name:URSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:38 JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-321-8337
Mailing Address - Fax:631-321-9347
Practice Address - Street 1:38 JAMES STREET
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-321-8337
Practice Address - Fax:631-321-9347
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307432-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health