Healthcare Provider Details

I. General information

NPI: 1831603919
Provider Name (Legal Business Name): WHALYNN DOMINIQUE-SANON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLZ FL 8
NEW YORK NY
10119-0899
US

IV. Provider business mailing address

60 FALLON AVE
ELMONT NY
11003-3607
US

V. Phone/Fax

Practice location:
  • Phone: 203-554-7786
  • Fax:
Mailing address:
  • Phone: 516-560-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number342213
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number342213
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number342213
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number342213
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number342213
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number342213
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342213
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number342213
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: