Healthcare Provider Details

I. General information

NPI: 1720916521
Provider Name (Legal Business Name): HADIYA DORVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 18TH AVE
BROOKLYN NY
11204-3729
US

IV. Provider business mailing address

6424 18TH AVE
BROOKLYN NY
11204-3729
US

V. Phone/Fax

Practice location:
  • Phone: 516-428-8019
  • Fax:
Mailing address:
  • Phone: 516-428-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN36544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: