Provider Demographics
NPI:1871522706
Name:OTELLO, TONI ANNE (ANP)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:ANNE
Last Name:OTELLO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 INTERVALE AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-4240
Mailing Address - Country:US
Mailing Address - Phone:718-732-7171
Mailing Address - Fax:718-732-7183
Practice Address - Street 1:900 INTERVALE AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4240
Practice Address - Country:US
Practice Address - Phone:718-732-7171
Practice Address - Fax:718-732-7171
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304241363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health