Provider Demographics
NPI:1356163281
Name:DAPONTE, RANDI E (RN IBCLC)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:E
Last Name:DAPONTE
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1112
Mailing Address - Country:US
Mailing Address - Phone:631-926-7143
Mailing Address - Fax:
Practice Address - Street 1:2 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1112
Practice Address - Country:US
Practice Address - Phone:631-926-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY411585163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant