Individual ProviderAdrienne DattaPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address475 Seaview Ave, Staten Island, NY 10305-3436(718) 226-9360(619) 201-4954PECOS EnrollmentBased on the most recent information from CMS, provider Adrienne Datta is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1558849091Provider TypeIndividualFull NameDatta, AdrienneCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date8/6/2018Last Updated10/17/2018Contact InformationPractice LocationPractice Address475 Seaview Ave, Staten Island, NY 10305-3436Phone(718) 226-9360Fax(718) 226-1128Mailing LocationMailing Address165 Park Row Apt 3d, New York, NY 10038-1104Phone(619) 201-4954FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense022626New YorkCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer