Provider Demographics
NPI:1245654920
Name:D'AGOSTINO, CONSUELO ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:CONSUELO
Middle Name:ELIZABETH
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4 REVERE DR E
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2815
Mailing Address - Country:US
Mailing Address - Phone:626-826-8981
Mailing Address - Fax:
Practice Address - Street 1:4 REVERE DR E
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2815
Practice Address - Country:US
Practice Address - Phone:626-826-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017368363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical