Healthcare Provider Details

I. General information

NPI: 1477181360
Provider Name (Legal Business Name): DIEU BUI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE STE 340
SYRACUSE NY
13210-1605
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2866
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7747
  • Fax: 315-470-7758
Mailing address:
  • Phone: 315-937-3433
  • Fax: 315-937-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026002
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: