Healthcare Provider Details

I. General information

NPI: 1396652947
Provider Name (Legal Business Name): AUDREE DESSAINT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KEMPF ST
NESCONSET NY
11767-3305
US

IV. Provider business mailing address

11 KEMPF ST
NESCONSET NY
11767-3305
US

V. Phone/Fax

Practice location:
  • Phone: 631-672-7867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number398019410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: