Healthcare Provider Details

I. General information

NPI: 1285525626
Provider Name (Legal Business Name): DIANNE COLLAZO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BROADHOLLOW RD STE 201
MELVILLE NY
11747-4833
US

IV. Provider business mailing address

17 OAKWOOD ST
BLUE POINT NY
11715-1115
US

V. Phone/Fax

Practice location:
  • Phone: 914-216-7585
  • Fax:
Mailing address:
  • Phone: 631-252-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number433785-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number433785-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number433785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: