Active NPI
Andrea Dellal
- Family Nurse Practitioner
- Port Washington, NY
National Provider Identifier
1851167894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 353527
- Practice address
- 20C Main St
Port Washington, NY 11050-2917 - Phone
- (631) 505-1036
- NPI assigned
- Nov 30, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 353527 | NY | Primary |
Addresses
Primary practice location
20C Main St
Port Washington, NY 11050-2917
Mailing address
20C Main St
Port Washington, NY 11050-2917
Phone (631) 505-1036
Other names 1
- Mrs. Andrea Dellal
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 353527 | NY | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725321600000",
"number": "1851167894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20C MAIN ST",
"city": "PORT WASHINGTON",
"state": "NY",
"postal_code": "110502917",
"telephone_number": "631-505-1036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20C MAIN ST",
"city": "PORT WASHINGTON",
"state": "NY",
"postal_code": "110502917",
"telephone_number": "631-505-1036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELLAL",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-30",
"last_updated": "2024-09-03",
"certification_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "353527",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ANDREA",
"last_name": "DELLAL",
"prefix": "MRS.",
"credential": "FNP-BC",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Port Washington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.