Healthcare Provider Details

I. General information

NPI: 1679420905
Provider Name (Legal Business Name): MAILYN MAE DE DIOS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 66TH DR
MIDDLE VILLAGE NY
11379-2109
US

IV. Provider business mailing address

7117 66TH DR
MIDDLE VILLAGE NY
11379-2109
US

V. Phone/Fax

Practice location:
  • Phone: 917-755-9256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: