Provider Demographics
NPI:1326380825
Name:DORNEVIL, MARIE D'KHARELDE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:D'KHARELDE
Last Name:DORNEVIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1214
Mailing Address - Country:US
Mailing Address - Phone:347-535-2802
Mailing Address - Fax:
Practice Address - Street 1:279 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1214
Practice Address - Country:US
Practice Address - Phone:347-535-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4306891207R00000X
NYF404425-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine