Healthcare Provider Details

I. General information

NPI: 1649520370
Provider Name (Legal Business Name): DEBORAH FELICIANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 RESEARCH WAY SUITE 500
EAST SETAUKET NY
11733-3487
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-6270
  • Fax: 631-638-0935
Mailing address:
  • Phone: 631-444-0560
  • Fax: 631-638-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number306090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: