Provider Demographics
NPI:1063864692
Name:ISAGUIRRE, DERLY LILIANA
Entity Type:Individual
Prefix:
First Name:DERLY
Middle Name:LILIANA
Last Name:ISAGUIRRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3214
Mailing Address - Country:US
Mailing Address - Phone:631-334-7419
Mailing Address - Fax:
Practice Address - Street 1:94 PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3214
Practice Address - Country:US
Practice Address - Phone:631-334-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator