Healthcare Provider Details

I. General information

NPI: 1033520267
Provider Name (Legal Business Name): DIEULIRA PHILIPPE JEANOUTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SUFFERN PL
GARNERVILLE NY
10923-1127
US

IV. Provider business mailing address

2 SUFFERN PL
GARNERVILLE NY
10923-1127
US

V. Phone/Fax

Practice location:
  • Phone: 845-494-5942
  • Fax:
Mailing address:
  • Phone: 845-494-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358970-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: