Healthcare Provider Details

I. General information

NPI: 1164759668
Provider Name (Legal Business Name): FRANTZCHESCA DECADE DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S HOWELL AVE STE D
CENTEREACH NY
11720-4445
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2274
  • Fax:
Mailing address:
  • Phone: 631-444-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number6076111
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: