Healthcare Provider Details

I. General information

NPI: 1487567046
Provider Name (Legal Business Name): MISS DIANNE SUROJANOE GRIMMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 REMSEN AVE
BROOKLYN NY
11236-3451
US

IV. Provider business mailing address

8714 LIBERTY AVE
OZONE PARK NY
11417-1327
US

V. Phone/Fax

Practice location:
  • Phone: 718-303-3245
  • Fax:
Mailing address:
  • Phone: 717-948-1900
  • 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 StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: