Provider Demographics
NPI:1295412831
Name:DELUREY, TARA ROSE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ROSE
Last Name:DELUREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:R
Other - Last Name:DELUREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 WOODMERE RD
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-1111
Mailing Address - Country:US
Mailing Address - Phone:631-804-9979
Mailing Address - Fax:
Practice Address - Street 1:495 HOFFMAN LN STE 3
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3102
Practice Address - Country:US
Practice Address - Phone:631-863-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant