Provider Demographics
NPI:1134475189
Name:DEACON, NANCY C (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:DEACON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 SALEM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-636-7050
Mailing Address - Fax:631-549-1097
Practice Address - Street 1:150 BROADHOLLOW ROAD
Practice Address - Street 2:SUITE 310
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:631-636-7050
Practice Address - Fax:631-423-2111
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2015-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY401496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health