Provider Demographics
NPI:1174258024
Name:ROBERTS, DOLETTE URANNIE
Entity type:Individual
Prefix:MS
First Name:DOLETTE
Middle Name:URANNIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10370 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1732
Mailing Address - Country:US
Mailing Address - Phone:516-838-9384
Mailing Address - Fax:
Practice Address - Street 1:10370 103RD ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1732
Practice Address - Country:US
Practice Address - Phone:516-838-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency