Dr. Devon Cordelia Gordon-Lyles, AGPNP-BC, CCRN
Nurse Practitioner, Adult Health in Teaneck, NJ. Individual provider (NPI-1).
NPI number1750120408
StatusActive
Last updated in NPPESMar 27, 2025
Details
- NPI
- 1750120408
- Entity type
- Individual (NPI-1)
- Name
- Dr. Devon Cordelia Gordon-Lyles
- Credential
- AGPNP-BC, CCRN
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 22, 2024
- Certification date
- Mar 27, 2025
- Last updated
- Mar 27, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LA2200X | Nurse Practitioner, Adult Health | F311813-01 | NY | Yes |
| 363L00000X | Nurse Practitioner | 26NJ15075500 | NJ |
Practice location
157 Shepard AveTeaneck, NJ 07666-6157
Phone 201-937-6516
Mailing address
157 Shepard AveTeaneck, NJ 07666-6157
Phone 201-937-6516
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