Provider Demographics
NPI:1225715287
Name:DORSAINVIL, KERLANDE
Entity Type:Individual
Prefix:
First Name:KERLANDE
Middle Name:
Last Name:DORSAINVIL
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 1:81 ROCKMART AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1728
Mailing Address - Country:US
Mailing Address - Phone:516-668-1415
Mailing Address - Fax:
Practice Address - Street 1:11339 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2425
Practice Address - Country:US
Practice Address - Phone:516-668-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY468335299172A00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No172A00000XOther Service ProvidersDriver