Provider Demographics
NPI:1023008224
Name:DUNHAM, ELEANOR MELLON (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:MELLON
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-3956
Mailing Address - Country:US
Mailing Address - Phone:631-287-1545
Mailing Address - Fax:
Practice Address - Street 1:335B MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5051
Practice Address - Country:US
Practice Address - Phone:631-287-5990
Practice Address - Fax:631-287-5995
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420361363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health