Healthcare Provider Details

I. General information

NPI: 1063024115
Provider Name (Legal Business Name): DYNAMIC DOULA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 TOC DR UNIT 602
HIGHLAND NY
12528-1556
US

IV. Provider business mailing address

42 TOC DR UNIT 602
HIGHLAND NY
12528-1556
US

V. Phone/Fax

Practice location:
  • Phone: 516-467-9250
  • Fax: 516-467-9250
Mailing address:
  • Phone: 516-467-9250
  • Fax: 845-834-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TANIA MYRTHIL
Title or Position: REGISTERED NURSE, DOULA
Credential: RN
Phone: 516-467-9250