Provider Demographics
NPI:1609646553
Name:DEYOUNG, DEREK PAUL (RN)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:PAUL
Last Name:DEYOUNG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SYLVAN PKWY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1514
Mailing Address - Country:US
Mailing Address - Phone:716-812-5356
Mailing Address - Fax:716-816-2161
Practice Address - Street 1:400 FOREST AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1207
Practice Address - Country:US
Practice Address - Phone:716-816-2444
Practice Address - Fax:716-816-2161
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635025163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator