1841504404 NPI number — SHAUNA DEL PRETE R.D.

Table of content: SHAUNA DEL PRETE R.D. (NPI 1841504404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841504404 NPI number — SHAUNA DEL PRETE R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL PRETE
Provider First Name:
SHAUNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACE
Provider Other First Name:
SHAUNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841504404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/06/2017
NPI Reactivation Date:
01/23/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MELANIE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-5830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-835-9191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 AVALON SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN COVE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11542-2845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-835-9191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)