Healthcare Provider Details

I. General information

NPI: 1881189660
Provider Name (Legal Business Name): DAPHNEE BEAULIEU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MASON AVE FL 3
STATEN ISLAND NY
10305-3408
US

IV. Provider business mailing address

256 MASON AVE FL 3
STATEN ISLAND NY
10305-3408
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-6398
  • Fax: 718-226-1247
Mailing address:
  • Phone: 718-226-6398
  • Fax: 718-226-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number326972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: