Healthcare Provider Details

I. General information

NPI: 1942110994
Provider Name (Legal Business Name): MAKECHNY VALCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 FELLER DR
CENTRAL ISLIP NY
11722-1214
US

IV. Provider business mailing address

282 FELLER DR
CENTRAL ISLIP NY
11722-1214
US

V. Phone/Fax

Practice location:
  • Phone: 631-214-7594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number979783-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: