Healthcare Provider Details

I. General information

NPI: 1710122767
Provider Name (Legal Business Name): SI YAN DIANA DOU RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 E RAILROAD AVE
JAMESBURG NJ
08831-1207
US

IV. Provider business mailing address

322 WILLOW WINDS PKWY
SAINT JOHNS FL
32259-7268
US

V. Phone/Fax

Practice location:
  • Phone: 732-561-8555
  • Fax: 732-561-1165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number013054
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP001414400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: