Healthcare Provider Details

I. General information

NPI: 1023904638
Provider Name (Legal Business Name): ALEYA JASMINE DECOURSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NORFLEET LN
CORAM NY
11727-4051
US

IV. Provider business mailing address

104 NORFLEET LN
CORAM NY
11727-4051
US

V. Phone/Fax

Practice location:
  • Phone: 631-552-7116
  • Fax:
Mailing address:
  • Phone: 631-552-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN46123
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number347229
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberTEMP1242437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: