Healthcare Provider Details

I. General information

NPI: 1942127394
Provider Name (Legal Business Name): DIAMANI DONTAY BERMUDEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1496
US

IV. Provider business mailing address

1575 N THOMPSON DR
BAY SHORE NY
11706-1324
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408682
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: