Healthcare Provider Details

I. General information

NPI: 1619980976
Provider Name (Legal Business Name): LAUREL ANNE DELORME P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 BREWERTON RD
CICERO NY
13039-9528
US

IV. Provider business mailing address

PO BOX 248
ELLICOTTVILLE NY
14731-0248
US

V. Phone/Fax

Practice location:
  • Phone: 315-288-4006
  • Fax: 315-288-4760
Mailing address:
  • Phone: 716-699-9032
  • Fax: 716-699-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: