Individual
DALAS TADDEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4490 EXPRESS DRIVE S, RONKONKOMA, NY 11779
(718) 578-9719
Mailing address
4490 EXPRESS DR S, RONKONKOMA, NY 11779-5532
(718) 578-9719
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
231514-1
NY
Other
Enumeration date
06/15/2017
Last updated
07/21/2022
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