Healthcare Provider Details

I. General information

NPI: 1679959670
Provider Name (Legal Business Name): DAIAMY OSORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ROBINSON RD
CLINTON NY
13323-1418
US

IV. Provider business mailing address

19 ROBINSON RD
CLINTON NY
13323-1418
US

V. Phone/Fax

Practice location:
  • Phone: 315-853-6090
  • Fax: 315-853-3190
Mailing address:
  • Phone: 315-853-6090
  • Fax: 315-853-3190

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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: