Provider Demographics
NPI:1326379215
Name:ENEA, DEBORAH (RN,NPP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ENEA
Suffix:
Gender:F
Credentials:RN,NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PAPROCKI AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2915
Mailing Address - Country:US
Mailing Address - Phone:516-380-3723
Mailing Address - Fax:
Practice Address - Street 1:24 PAPROCKI AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2915
Practice Address - Country:US
Practice Address - Phone:516-380-3723
Practice Address - Fax:631-661-1094
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400246363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health