Healthcare Provider Details

I. General information

NPI: 1003203209
Provider Name (Legal Business Name): NYA DOBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 04/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMDEN AVE
SALISBURY MD
21801-6837
US

IV. Provider business mailing address

96 GLENSIDE TRL
SPARTA NJ
07871-1230
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-6000
  • Fax:
Mailing address:
  • Phone: 973-997-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: