Healthcare Provider Details

I. General information

NPI: 1205752045
Provider Name (Legal Business Name): GILLAIN CONSTANTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 W BALTIMORE PIKE
MEDIA PA
19063-5139
US

IV. Provider business mailing address

1504 PAINTERS XING
CHADDS FORD PA
19317-9652
US

V. Phone/Fax

Practice location:
  • Phone: 484-227-8612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN788243
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: