Provider Demographics
NPI:1447859574
Name:FELINOR, LYNNEDELL
Entity type:Individual
Prefix:
First Name:LYNNEDELL
Middle Name:
Last Name:FELINOR
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 1:2037 UTICA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3234
Mailing Address - Country:US
Mailing Address - Phone:718-377-7757
Mailing Address - Fax:718-758-9497
Practice Address - Street 1:2037 UTICA AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3234
Practice Address - Country:US
Practice Address - Phone:718-377-7757
Practice Address - Fax:718-758-9497
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist