Provider Demographics
NPI:1386350288
Name:DOUMAZIOS, GABRIELLA DESIREE
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:DESIREE
Last Name:DOUMAZIOS
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 1:89 HIDDEN PONDS CIR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5227
Mailing Address - Country:US
Mailing Address - Phone:516-761-0492
Mailing Address - Fax:
Practice Address - Street 1:80 ARKAY DR STE 230
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3705
Practice Address - Country:US
Practice Address - Phone:917-730-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737096163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse