MEDICARE: DELENN LLOYD-LATIF PA-C

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	026429	NY

General Provider Information

NPI Number	:	1962046169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELENN LLOYD-LATIF PA-C

Provider Business Mailing Address
First Line	:	160 CONVENT AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-9101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 CONVENT AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-9101
Country	:	US
Telephone Number	:	518-728-0270
Fax Number	:

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

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	08/13/2025

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