Healthcare Provider Details

I. General information

NPI: 1194615500
Provider Name (Legal Business Name): DIANA EUCEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WINTERSON RD STE 160
LINTHICUM MD
21090-2245
US

IV. Provider business mailing address

14 20TH AVE
BAY SHORE NY
11706-3111
US

V. Phone/Fax

Practice location:
  • Phone: 410-684-3806
  • Fax:
Mailing address:
  • Phone: 631-452-4895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberA01077
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: