Healthcare Provider Details

I. General information

NPI: 1730802430
Provider Name (Legal Business Name): JULIA DYO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TOMPKINS AVE
STATEN ISLAND NY
10304-2601
US

IV. Provider business mailing address

21 PERSIMMON LN
STATEN ISLAND NY
10314-4954
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-1200
  • Fax:
Mailing address:
  • Phone: 917-340-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2078751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: