Healthcare Provider Details

I. General information

NPI: 1316360936
Provider Name (Legal Business Name): DEEKA-GAYE COLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEKA-GAYE GRAHAMM NP

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 SEAGIRT BLVD
FAR ROCKAWAY NY
11691-2940
US

IV. Provider business mailing address

2035 SEAGIRT BLVD APT 2B
FAR ROCKAWAY NY
11691-2936
US

V. Phone/Fax

Practice location:
  • Phone: 347-995-5776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: