Healthcare Provider Details

I. General information

NPI: 1659204790
Provider Name (Legal Business Name): DESIREE KIMBERLY RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 EL CAMINO LOOP
STATEN ISLAND NY
10309-2852
US

IV. Provider business mailing address

155 EL CAMINO LOOP
STATEN ISLAND NY
10309-2852
US

V. Phone/Fax

Practice location:
  • Phone: 347-951-0110
  • Fax:
Mailing address:
  • Phone: 347-951-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number842803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: