Provider Demographics
NPI:1184999872
Name:ENDARA, FELICIA JOY (RN, LPN)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:JOY
Last Name:ENDARA
Suffix:
Gender:F
Credentials:RN, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4834
Mailing Address - Country:US
Mailing Address - Phone:631-466-2226
Mailing Address - Fax:
Practice Address - Street 1:202 BEAVER DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-2812
Practice Address - Country:US
Practice Address - Phone:631-466-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY653008163W00000X, 163WH0200X
NY295347164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse