Healthcare Provider Details

I. General information

NPI: 1518934983
Provider Name (Legal Business Name): SUSAN ANNE DAIUTO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 VICTORY BLVD
STATEN ISLAND NY
10314-3529
US

IV. Provider business mailing address

239 NATICK ST
STATEN ISLAND NY
10306-1625
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-5437
  • Fax: 718-980-0974
Mailing address:
  • Phone: 718-668-1241
  • Fax: 718-980-0974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number196996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: