Provider Demographics
NPI:1881714244
Name:PADUANO, DARLENE JOAN (NP)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:JOAN
Last Name:PADUANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1091
Mailing Address - Country:US
Mailing Address - Phone:631-584-0069
Mailing Address - Fax:631-686-5580
Practice Address - Street 1:57 SOUTHERN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1091
Practice Address - Country:US
Practice Address - Phone:631-584-0069
Practice Address - Fax:631-686-5580
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301096-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF301096-1OtherLICENSE
NYF301096-1OtherLICENSE