Healthcare Provider Details

I. General information

NPI: 1063028041
Provider Name (Legal Business Name): ALANNA NOCEDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 N OCEAN AVE
MEDFORD NY
11763-2687
US

IV. Provider business mailing address

180 E MAIN ST
BAY SHORE NY
11706-8427
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-5858
  • Fax:
Mailing address:
  • Phone: 631-780-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number309684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: