Healthcare Provider Details

I. General information

NPI: 1134043292
Provider Name (Legal Business Name): TRICIA LICHUN DINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVE
ALBANY NY
12208-3835
US

IV. Provider business mailing address

312 BRAM HALL DR
ROCHESTER NY
14626-5239
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5640
  • Fax:
Mailing address:
  • Phone: 585-353-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: