Provider Demographics
NPI:1730722455
Name:KAMARA, FATMATA A
Entity type:Individual
Prefix:
First Name:FATMATA
Middle Name:A
Last Name:KAMARA
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 1:1750 SEDGWICK AVE APT 5K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6611
Mailing Address - Country:US
Mailing Address - Phone:917-640-6167
Mailing Address - Fax:
Practice Address - Street 1:1750 SEDGWICK AVE APT 5K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6611
Practice Address - Country:US
Practice Address - Phone:917-640-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse