MEDICARE: LATOYA LORRINE DEAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1447949193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA LORRINE DEAS

Provider Business Mailing Address
First Line	:	1655 UNION STREET APT D3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213
Country	:	US
Telephone Number	:	917-889-5961
Fax Number	:

Provider Business Practice Location Address
First Line	:	84-03 CUTHBERT RD.
Second Line	:
City	:	KEW GARDENS, NY 1141
State	:	NY
Zip	:	11415
Country	:	US
Telephone Number	:	347-454-9082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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Directions to “ LATOYA LORRINE DEAS ” Practice Location

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