Healthcare Provider Details

I. General information

NPI: 1588479299
Provider Name (Legal Business Name): VALERIE D'ANTONIO SERVICE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY UNIT 2
OAKDALE NY
11769-1492
US

IV. Provider business mailing address

58 FREDERICK ST
BOHEMIA NY
11716-3915
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax:
Mailing address:
  • Phone: 631-334-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: