Provider Demographics
NPI:1477625176
Name:DELEGUARDIA, DAWNA ESTELLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:DAWNA
Middle Name:ESTELLE
Last Name:DELEGUARDIA
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 1:101 SWEET BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1215
Mailing Address - Country:US
Mailing Address - Phone:585-621-4080
Mailing Address - Fax:
Practice Address - Street 1:101 SWEET BIRCH LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1215
Practice Address - Country:US
Practice Address - Phone:585-621-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278871164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02688237Medicaid