Individual
MR. DWAYNE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
31 COVERT AVE # 1030, FLORAL PARK, NY 11001-3216
(516) 402-0194
(516) 232-9534
Mailing address
31 COVERT AVE # 1030, FLORAL PARK, NY 11001-3216
(516) 402-0194
(518) 933-2531
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
348517
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
407104
NY
Other
Enumeration date
11/02/2021
Last updated
07/01/2025
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