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General NPI Number Information
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NPI Number | 1891170544
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Entity Type | Organization
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Legal Business Name | NANCY C. DEACON, PSYCHIATRIC NURSE PRACTITIONER, P.C.
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 80 SALEM RIDGE DR
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City | HUNTINGTON
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State | NY
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Zip | 11743-3015
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Country | US
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Telephone | 631-495-7762
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Fax |
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Provider Business Mailing Address
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Address Line | 150 BROADHOLLOW RD SUITE 310
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City | MELVILLE
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State | NY
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Zip | 11747-4905
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Country | US
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Telephone | 631-636-7050
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Fax | 631-549-1097
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NANCY DEACON
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Credential |
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Telephone | 631-495-7762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F401406-1
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License Number State | NY
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