Healthcare Provider Details

I. General information

NPI: 1851614077
Provider Name (Legal Business Name): AMY DABO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16937 144TH RD
JAMAICA NY
11434-5929
US

IV. Provider business mailing address

695 SAINT NICHOLAS AVE APT 54
NEW YORK NY
10030-1050
US

V. Phone/Fax

Practice location:
  • Phone: 718-978-7226
  • Fax: 718-978-0032
Mailing address:
  • Phone: 646-407-7584
  • Fax: 718-978-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number623670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: