MEDICARE: GWENDOLYN DELVALLE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R255408	MD

General Provider Information

NPI Number	:	1174949432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN DELVALLE NP

Provider Business Mailing Address
First Line	:	1999 MARCUS AVE STE 220
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1021
Country	:	US
Telephone Number	:	516-335-5525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1999 MARCUS AVE STE 220
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1021
Country	:	US
Telephone Number	:	516-335-5525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	05/13/2026

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