Provider Demographics
NPI:1477278240
Name:MCINTOSH, RROYA-RAE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:RROYA-RAE
Middle Name:MARIE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RROYA-RAE
Other - Middle Name:
Other - Last Name:DALEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20906 NASHVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1041
Mailing Address - Country:US
Mailing Address - Phone:954-663-1046
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350557363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty