Provider Demographics
NPI:1548978356
Name:BACAYANA, ROCHELLE KAYE
Entity type:Individual
Prefix:
First Name:ROCHELLE KAYE
Middle Name:
Last Name:BACAYANA
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 1:19 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3515
Mailing Address - Country:US
Mailing Address - Phone:917-690-3612
Mailing Address - Fax:
Practice Address - Street 1:19 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3515
Practice Address - Country:US
Practice Address - Phone:917-690-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY824779163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse