Healthcare Provider Details

I. General information

NPI: 1992723167
Provider Name (Legal Business Name): DOREEN DELANEY P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 HALLOCK AVE
PORT JEFFERSON STATION NY
11776-2048
US

IV. Provider business mailing address

1110 HALLOCK AVE
PORT JEFFERSON STATION NY
11776-2048
US

V. Phone/Fax

Practice location:
  • Phone: 631-476-9100
  • Fax: 631-476-4919
Mailing address:
  • Phone: 631-476-9100
  • Fax: 631-476-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0062761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: