Provider Demographics
NPI:1770175184
Name:DOCKERY, TOWANA ANN
Entity type:Individual
Prefix:
First Name:TOWANA
Middle Name:ANN
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LINCOLN AVE WYANDANCH NY 11798
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798
Mailing Address - Country:US
Mailing Address - Phone:631-920-0365
Mailing Address - Fax:
Practice Address - Street 1:13 LINCOLN AVE WYANDANCH NY 11798
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-1179
Practice Address - Country:US
Practice Address - Phone:631-920-0365
Practice Address - Fax:631-920-0365
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health