Provider Demographics
NPI:1700652013
Name:FONTANA, ALEXANDRA DESPINA (NP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DESPINA
Last Name:FONTANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MOTOR PKWY STE LL8
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:833-547-7463
Mailing Address - Fax:631-318-9830
Practice Address - Street 1:340 HOWELLS RD STE 2B
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5322
Practice Address - Country:US
Practice Address - Phone:833-547-7463
Practice Address - Fax:631-318-9830
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF351883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty