Provider Demographics
NPI:1568784775
Name:LAMENDOLA, DEBORAH ANN (MS, APRN, BC, CWCN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:LAMENDOLA
Suffix:
Gender:F
Credentials:MS, APRN, BC, CWCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6546
Mailing Address - Country:US
Mailing Address - Phone:631-585-4531
Mailing Address - Fax:631-474-4594
Practice Address - Street 1:5225 NESCONSET HWY STE 53
Practice Address - Street 2:BLDG. 12
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2061
Practice Address - Country:US
Practice Address - Phone:631-474-4590
Practice Address - Fax:631-474-4594
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300583-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health