Provider Demographics
NPI:1053527143
Name:ST.VICTOR, GUITELLE (MD)
Entity type:Individual
Prefix:DR
First Name:GUITELLE
Middle Name:
Last Name:ST.VICTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GUITELLE
Other - Middle Name:
Other - Last Name:ST.VICTOR-HAMIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2201 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-572-6511
Mailing Address - Fax:516-572-3210
Practice Address - Street 1:2201 HEMPSTEAD TURNPIKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-572-6511
Practice Address - Fax:516-572-3210
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24159112084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine