Healthcare Provider Details

I. General information

NPI: 1225357007
Provider Name (Legal Business Name): DAMALI M. WILSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAMALI M. RAHMAN

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9708 SEAVIEW AVE
BROOKLYN NY
11236-5516
US

IV. Provider business mailing address

135 MINEOLA BLVD FL 2
MINEOLA NY
11501-3917
US

V. Phone/Fax

Practice location:
  • Phone: 718-444-0520
  • Fax: 718-444-1898
Mailing address:
  • Phone: 917-310-3371
  • Fax: 516-938-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1016778
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: