Healthcare Provider Details

I. General information

NPI: 1124828934
Provider Name (Legal Business Name): DOREEN NASTASIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MARBLE AVE STE 5
PLEASANTVILLE NY
10570-3451
US

IV. Provider business mailing address

PO BOX 28
SOUTH SALEM NY
10590-0028
US

V. Phone/Fax

Practice location:
  • Phone: 914-747-4247
  • Fax:
Mailing address:
  • Phone: 914-747-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: