Provider Demographics
NPI:1932901782
Name:PERCELL, DEVONJAE ANTHONY
Entity type:Individual
Prefix:
First Name:DEVONJAE
Middle Name:ANTHONY
Last Name:PERCELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 237TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1041
Mailing Address - Country:US
Mailing Address - Phone:347-585-7326
Mailing Address - Fax:
Practice Address - Street 1:12840 237TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1041
Practice Address - Country:US
Practice Address - Phone:347-585-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY862771163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health