Provider Demographics
NPI:1235491606
Name:DELISLE, LYNN M (MSED)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:DELISLE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3812
Mailing Address - Country:US
Mailing Address - Phone:518-272-2236
Mailing Address - Fax:518-272-2213
Practice Address - Street 1:21 1ST ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3812
Practice Address - Country:US
Practice Address - Phone:518-272-2236
Practice Address - Fax:518-272-2213
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist