Provider Demographics
NPI:1093261398
Name:DEDONATIS, ANTHONY MICHAEL (PMHNP-BC, RN-BC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:DEDONATIS
Suffix:
Gender:M
Credentials:PMHNP-BC, RN-BC
Other - Prefix:MR
Other - First Name:ANTONY
Other - Middle Name:MICHAEL
Other - Last Name:DEDONATIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC, RN-BC
Mailing Address - Street 1:420 E 76TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3396
Practice Address - Country:US
Practice Address - Phone:212-434-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402061363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health