Provider Demographics
NPI:1871057380
Name:PEIGNE DELPHIN, MYRLANDE (LPN)
Entity type:Individual
Prefix:
First Name:MYRLANDE
Middle Name:
Last Name:PEIGNE DELPHIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6816
Mailing Address - Country:US
Mailing Address - Phone:347-469-2858
Mailing Address - Fax:
Practice Address - Street 1:2613 21ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3544
Practice Address - Country:US
Practice Address - Phone:718-626-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343736470915E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide