Provider Demographics
NPI:1699941971
Name:GAVILANES, NYCHOLLE LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:NYCHOLLE
Middle Name:LYNNE
Last Name:GAVILANES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8 TECHNOLOGY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:516-704-7447
Mailing Address - Fax:516-734-6312
Practice Address - Street 1:8 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:516-704-7447
Practice Address - Fax:516-734-6312
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY263634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine