Healthcare Provider Details

I. General information

NPI: 1851798433
Provider Name (Legal Business Name): DENISHA DODD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MARSHALL CT
UNIONDALE NY
11553
US

IV. Provider business mailing address

511 MARSHALL CT
UNIONDALE NY
11553-2111
US

V. Phone/Fax

Practice location:
  • Phone: 631-577-5274
  • Fax:
Mailing address:
  • Phone: 516-236-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberF338106
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number623369
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: