Healthcare Provider Details

I. General information

NPI: 1649210592
Provider Name (Legal Business Name): EUNICE Y NAYO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S FRANKLIN ST
WATKINS GLEN NY
14891-1529
US

IV. Provider business mailing address

2194 GRAND CENTRAL AVE
HORSEHEADS NY
14845-2661
US

V. Phone/Fax

Practice location:
  • Phone: 607-535-5529
  • Fax: 607-535-5531
Mailing address:
  • Phone: 607-795-0555
  • Fax: 607-795-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number199997
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: