Provider Demographics
NPI:1407211196
Name:GUILLAUME, LENDSA
Entity Type:Individual
Prefix:
First Name:LENDSA
Middle Name:
Last Name:GUILLAUME
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 1:1258 WESTERVELT PL
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1208
Mailing Address - Country:US
Mailing Address - Phone:516-250-3266
Mailing Address - Fax:516-250-3266
Practice Address - Street 1:1258 WESTERVELT PL
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1208
Practice Address - Country:US
Practice Address - Phone:516-250-3266
Practice Address - Fax:516-250-3266
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22568330163W00000X
NYF403647-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse