Provider Demographics
NPI:1326328386
Name:DELVALLE, CARLY M (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:M
Last Name:DELVALLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 HIRAM AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-5709
Mailing Address - Country:US
Mailing Address - Phone:516-356-0723
Mailing Address - Fax:
Practice Address - Street 1:1378 HIRAM AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-5709
Practice Address - Country:US
Practice Address - Phone:516-356-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300245-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse