Provider Demographics
NPI:1598835498
Name:DELGAUDIO, DINO JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DINO
Middle Name:JOHN
Last Name:DELGAUDIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 193RD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2400
Mailing Address - Country:US
Mailing Address - Phone:718-460-2644
Mailing Address - Fax:
Practice Address - Street 1:3621 193RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2400
Practice Address - Country:US
Practice Address - Phone:718-460-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009526103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00980Medicare ID - Type Unspecified