Provider Demographics
NPI:1437521200
Name:BIRD, DEON ANGELA
Entity type:Individual
Prefix:
First Name:DEON
Middle Name:ANGELA
Last Name:BIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEON
Other - Middle Name:ANGELA
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:465 NEW HWY
Mailing Address - Street 2:APT D 22
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-1020
Mailing Address - Country:US
Mailing Address - Phone:631-761-3500
Mailing Address - Fax:631-761-3094
Practice Address - Street 1:465 NEW HWY
Practice Address - Street 2:APT D 22
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-1020
Practice Address - Country:US
Practice Address - Phone:631-761-3500
Practice Address - Fax:631-761-3094
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66941-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse