Provider Demographics
NPI:1063066058
Name:MASSEY, DOUGLAS OWEN (NP)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:OWEN
Last Name:MASSEY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EDGEWATER PL APT 304
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1622
Mailing Address - Country:US
Mailing Address - Phone:631-526-8223
Mailing Address - Fax:
Practice Address - Street 1:30 EDGEWATER PL APT 304
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1622
Practice Address - Country:US
Practice Address - Phone:631-526-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402743363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health