Healthcare Provider Details

I. General information

NPI: 1215368303
Provider Name (Legal Business Name): JENNIFER DESETTO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 DIVISION AVE
LEVITTOWN NY
11756-2999
US

IV. Provider business mailing address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

V. Phone/Fax

Practice location:
  • Phone: 516-313-4613
  • Fax:
Mailing address:
  • Phone: 516-632-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: