Healthcare Provider Details

I. General information

NPI: 1659764553
Provider Name (Legal Business Name): JOANNE DEGUIA-RAYOS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 OLD WESTBURY RD
OLD WESTBURY NY
11568-1611
US

IV. Provider business mailing address

70 OLD WESTBURY RD
OLD WESTBURY NY
11568-1611
US

V. Phone/Fax

Practice location:
  • Phone: 718-395-6444
  • Fax: 718-395-6661
Mailing address:
  • Phone: 718-395-6444
  • Fax: 718-395-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: