Healthcare Provider Details

I. General information

NPI: 1760424881
Provider Name (Legal Business Name): DILYS WHYTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

PO BOX 217
WEST ISLIP NY
11795-0217
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-2100
  • Fax:
Mailing address:
  • Phone: 631-465-6178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number193668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: