Provider Demographics
NPI:1629052972
Name:BOLLER DELANEY, MAUREEN ANNE (NPP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANNE
Last Name:BOLLER DELANEY
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3153
Mailing Address - Country:US
Mailing Address - Phone:917-837-2551
Mailing Address - Fax:718-565-8419
Practice Address - Street 1:75-20 ASTORIA BLVD.
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11370
Practice Address - Country:US
Practice Address - Phone:718-888-6794
Practice Address - Fax:718-565-8392
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400514 - 1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health