Healthcare Provider Details

I. General information

NPI: 1790346286
Provider Name (Legal Business Name): MISS JAIMIE DELFINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 FOREST AVE
STATEN ISLAND NY
10301-2638
US

IV. Provider business mailing address

22 DIRENZO CT
STATEN ISLAND NY
10309-3624
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-5678
  • Fax: 718-979-2969
Mailing address:
  • Phone: 347-405-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: