Provider Demographics
NPI:1891170544
Name:NANCY C. DEACON, PSYCHIATRIC NURSE PRACTITIONER, P.C.
Entity Type:Organization
Organization Name:NANCY C. DEACON, PSYCHIATRIC NURSE PRACTITIONER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-495-7762
Mailing Address - Street 1:150 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4905
Mailing Address - Country:US
Mailing Address - Phone:631-636-7050
Mailing Address - Fax:631-549-1097
Practice Address - Street 1:80 SALEM RIDGE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3015
Practice Address - Country:US
Practice Address - Phone:631-495-7762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401406-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty