Look up the most recent NPI and PECOS records

Dynella Russo

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

125 W Copeland Dr, Orlando, FL 32806-3280

(321) 841-7090 (201) 314-1902

PECOS Enrollment

Based on the most recent information from CMS, provider Dynella Russo is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1720496532
Provider Type
Individual
Full Name
Russo, Dynella
Title
Mrs.
Credential
FNP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
7/24/2014
Last Updated
5/11/2023

Contact Information

Practice Location

125 W Copeland Dr, Orlando, FL 32806-3280

(321) 841-7090

Unlisted Fax

Mailing Location

21 Armour Pl, Bergenfield, NJ 07621-1204

(201) 314-1902

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 26NJ00739600 New Jersey
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License 26NR16740400 New Jersey
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License 593722 New York

Dynella Russo

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Williams, Caitlin C

Bryden, Christine M

Serra, Maniya Nova

Martin, Megan Louise

Cook, Patriz Valerie Guevara

Francis, Shimoneh S

Vickers, Ileana

Heavey, Nicole

Ferguson, Cindy

Alvarez, Vivian Marie