Provider Demographics
NPI:1063659589
Name:GRAY, METHLYN DELORES (LPN)
Entity Type:Individual
Prefix:MS
First Name:METHLYN
Middle Name:DELORES
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:665 PELHAM PKWY N
Mailing Address - Street 2:#402
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8068
Mailing Address - Country:US
Mailing Address - Phone:718-519-8326
Mailing Address - Fax:718-881-8714
Practice Address - Street 1:665 PELHAM PKWY N
Practice Address - Street 2:#402
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8068
Practice Address - Country:US
Practice Address - Phone:718-519-8326
Practice Address - Fax:718-881-8714
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse