Daversa, Noelle Anne

Daversa, Noelle Anne is an individual health care provider with primary practice located at 208 Holly Lane , Smithtown NY 11787. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Daversa, Noelle Anne can be contacted via phone (631) 774-8665.

Contact Information

Primary practice address
208 Holly Lane Smithtown NY 11787
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 2233020 New York

Profile Details

NPI number 1619367778
LBN Legal business name Daversa, Noelle Anne
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 28th, 2015
Last updated Jan 28th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619367778 NPPES
New York MEDICAID 2238079

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