Active NPI
Gillian S Davalos, PA
- Physician Assistant
- Flushing, NY
National Provider Identifier
1669943973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 023052-1
- Practice address
- 5645 Main St
Flushing, NY 11355-5045 - Phone
- (347) 684-0011
- NPI assigned
- Dec 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 023052-1 | NY | Primary |
Addresses
Primary practice location
5645 Main St
Flushing, NY 11355-5045
Mailing address
23807 88TH Ave
Bellerose, NY 11426-1213
Phone (347) 859-9180
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023052-1 | NY | MD | Physician Assistant |
Interoperability endpoints
- gid9035@direct.nyp.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586908800000",
"number": "1669943973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23807 88TH AVE",
"city": "BELLEROSE",
"state": "NY",
"postal_code": "114261213",
"telephone_number": "347-859-9180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5645 MAIN ST",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113555045",
"telephone_number": "347-684-0011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVALOS",
"first_name": "GILLIAN",
"middle_name": "S",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-12",
"last_updated": "2020-04-15",
"certification_date": "2020-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "023052-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.