Provider Demographics
NPI:1578771895
Name:DAVIDE, LAURA ANNE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:DAVIDE
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Gender:F
Credentials:RPA-C
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Mailing Address - Street 1:1010 NORTHERN BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5329
Mailing Address - Country:US
Mailing Address - Phone:516-233-2484
Mailing Address - Fax:516-304-5850
Practice Address - Street 1:150 BROADHOLLOW RD STE 311
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4901
Practice Address - Country:US
Practice Address - Phone:631-470-7915
Practice Address - Fax:631-470-7922
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-10-23
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Provider Licenses
StateLicense IDTaxonomies
NY005989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant