Brenda Agatha Wyllie

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

444793 Issued in NY

Practice address

1516 Oriental Blvd
Brooklyn, NY 11235-2328

Phone

(718) 646-4441

NPI assigned

May 13, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1770157976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 ORIENTAL BLVD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112352328",
            "telephone_number": "718-368-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 ORIENTAL BLVD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112352328",
            "telephone_number": "718-646-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLLIE",
        "first_name": "BRENDA",
        "middle_name": "AGATHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "NY",
            "license": "444793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wyckoff Professional Medical Services, PC
• Wyckoff Specialty Script Corp
• Wyhomo LLC
• David Wyler
• Jessica Wylie
• Letoya Wyllie
• Anne Elizabeth Wyman, MD
• Ymoni Kristal Wyman
• Mahlik Wyndham
• Wynette Caesar Corp

• Gerontology Registered Nurse in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Gerontology Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.