Healthcare Provider Details

I. General information

NPI: 1518661297
Provider Name (Legal Business Name): DILAROM DEMIRALAY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 KOSSUTH AVE
BRONX NY
10467-2410
US

IV. Provider business mailing address

253 E 206TH ST # 4B
BRONX NY
10467-3701
US

V. Phone/Fax

Practice location:
  • Phone: 718-519-5056
  • Fax:
Mailing address:
  • Phone: 332-270-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP119722
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: