Provider Demographics
NPI:1386387447
Name:REYES, PAOLO ANGELO SANTOS (BSN, RN)
Entity type:Individual
Prefix:
First Name:PAOLO ANGELO
Middle Name:SANTOS
Last Name:REYES
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4335
Mailing Address - Country:US
Mailing Address - Phone:401-935-8634
Mailing Address - Fax:
Practice Address - Street 1:8610 54TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4335
Practice Address - Country:US
Practice Address - Phone:401-935-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY830139-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse