Provider Demographics
NPI:1881189660
Name:BEAULIEU, DAPHNEE (MD)
Entity type:Individual
Prefix:
First Name:DAPHNEE
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1617
Mailing Address - Country:US
Mailing Address - Phone:516-663-1145
Mailing Address - Fax:929-455-9927
Practice Address - Street 1:1111 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1617
Practice Address - Country:US
Practice Address - Phone:516-663-1145
Practice Address - Fax:929-455-9927
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326972207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine