Healthcare Provider Details

I. General information

NPI: 1649190869
Provider Name (Legal Business Name): DESTINY DANIYEL LEMARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NEIL CT
OCEANSIDE NY
11572-5815
US

IV. Provider business mailing address

810 GRAND TERRACE AVE
NORTH BALDWIN NY
11510-1423
US

V. Phone/Fax

Practice location:
  • Phone: 516-568-7858
  • Fax:
Mailing address:
  • Phone: 516-766-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP144110
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: