Healthcare Provider Details

I. General information

NPI: 1477967065
Provider Name (Legal Business Name): OKYRO CANDELARIA CLAUDIO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OKYRO CANDELARIA COLLAZO D.O.

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE STE 100
HEMPSTEAD NY
11550-3702
US

IV. Provider business mailing address

14 LUCILLE LN
DIX HILLS NY
11746-5810
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-1034
  • Fax:
Mailing address:
  • Phone: 718-551-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number287301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: