Provider Demographics
NPI:1114523362
Name:MEKKAWY, DALIA E
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:E
Last Name:MEKKAWY
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 1:7515 188TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1702
Mailing Address - Country:US
Mailing Address - Phone:646-707-1639
Mailing Address - Fax:
Practice Address - Street 1:29 HAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3901
Practice Address - Country:US
Practice Address - Phone:631-395-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist