Provider Demographics
NPI:1932497195
Name:MCDAY, DARLENE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:MCDAY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2717 SIPP AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2040
Mailing Address - Country:US
Mailing Address - Phone:631-294-0919
Mailing Address - Fax:
Practice Address - Street 1:75 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2119
Practice Address - Country:US
Practice Address - Phone:631-473-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2019-09-05
Deactivation Date:2019-08-26
Deactivation Code:
Reactivation Date:2019-09-05
Provider Licenses
StateLicense IDTaxonomies
NY645498163W00000X
NY309387363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse