ANGEL MIRACLE CARE NPI 1831943794

NPI Information

  • NPI: 1831943794
  • Provider Name: ANGEL MIRACLE CARE
  • Classification: Licensed Practical Nurse - 164W00000X
  • Entity Type: Organization
  • Address: 621 VANDERBILT LOOP
    YAPHANK, NY
    ZIP 11980
  • Phone: (516) 265-6525

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NPI Details

ANGEL MIRACLE CARE is a licensed practical nurse in Yaphank, NY. The provider is a licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. ANGEL MIRACLE CARE NPI is 1831943794. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

621 VANDERBILT LOOP
YAPHANK, NY
ZIP 11980-051
Phone: (516) 265-6525

The provider's authorized official is Shakiera Simone Bryant .
The authorized official title is Owner and has the following contact phone number (516) 265-6525.

The enumeration date for this NPI number is 4/16/2024 and was last updated on 9/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1164W00000XLicensed Practical NurseYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11205129103MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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