Healthcare Provider Details

I. General information

NPI: 1467193383
Provider Name (Legal Business Name): AMINA DJOZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMINA MUSIC

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N GENESEE ST
UTICA NY
13502-2529
US

IV. Provider business mailing address

1 WADSWORTH LN
UTICA NY
13501-5834
US

V. Phone/Fax

Practice location:
  • Phone: 315-275-3214
  • Fax: 315-275-3215
Mailing address:
  • Phone: 315-941-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF349043-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: