Provider Demographics
NPI:1063679942
Name:DETORE, SAILA (DO)
Entity Type:Individual
Prefix:DR
First Name:SAILA
Middle Name:
Last Name:DETORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2356
Mailing Address - Country:US
Mailing Address - Phone:631-661-2663
Mailing Address - Fax:631-321-4971
Practice Address - Street 1:403 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2356
Practice Address - Country:US
Practice Address - Phone:631-661-2663
Practice Address - Fax:631-321-4971
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6955207XX0801X
NY249749207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma