Individual provider Active NPI

Bonnie Lynn Gildea, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Valley Stream, NY
National Provider Identifier
1255400271
Registry record updated May 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F400429-1 Issued in NY
Practice address
50 W Hawthorne Ave
Valley Stream, NY 11580-6220
Phone
(516) 569-6600
Fax
(516) 374-2261
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F400429-1 NY Primary

Addresses

Primary practice location

50 W Hawthorne Ave
Valley Stream, NY 11580-6220

Mailing address

50 W Hawthorne Ave
Valley Stream, NY 11580-6220
Phone (516) 569-6600

Other identifiers 1

IdentifierTypeStateIssuer
02529986MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F400429-1NYMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337040000000",
    "number": "1255400271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 W HAWTHORNE AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115806220",
            "telephone_number": "516-569-6600",
            "fax_number": "516-374-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 W HAWTHORNE AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115806220",
            "telephone_number": "516-569-6600",
            "fax_number": "516-374-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILDEA",
        "first_name": "BONNIE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2012-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F400429-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02529986",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.