Provider Demographics
NPI:1386913127
Name:CABOT, DEBRA JEANNE (PNP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JEANNE
Last Name:CABOT
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2336
Mailing Address - Country:US
Mailing Address - Phone:631-434-2350
Mailing Address - Fax:
Practice Address - Street 1:795 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2336
Practice Address - Country:US
Practice Address - Phone:631-434-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381212-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics