MEDICARE: DR. DALILA E AGUILU LAVALETT MD

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	2084P0800X	Psychiatry Physician	8055	PR
2	2084P0804X	Child & Adolescent Psychiatry Physician	8055	PR
3	2084P0804X	Child & Adolescent Psychiatry Physician	24352	WI
4	2084P0800X	Psychiatry Physician	24352	WI
5	2084N0400X	Neurology Physician	283477	NY

General Provider Information

NPI Number	:	1306940630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALILA E AGUILU LAVALETT MD

Provider Business Mailing Address
First Line	:	1276 FULTON AVE
Second Line	:	ROOM 208
City	:	BRONX
State	:	NY
Zip	:	10456-3402
Country	:	US
Telephone Number	:	718-901-8918
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 FULTON AVE
Second Line	:	ROOM 208
City	:	BRONX
State	:	NY
Zip	:	10456-3402
Country	:	US
Telephone Number	:	718-901-8918
Fax Number	:

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	03/22/2017

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