Healthcare Provider Details

I. General information

NPI: 1811613433
Provider Name (Legal Business Name): MR. DARIUS II LAZARO OPADA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LUDLOW ST STE 402
YONKERS NY
10705-1949
US

IV. Provider business mailing address

417 FOOTHILLS PKWY NE # 417
GAINESVILLE GA
30501-3840
US

V. Phone/Fax

Practice location:
  • Phone: 347-667-7924
  • Fax: 332-262-2396
Mailing address:
  • Phone: 615-594-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN291021
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: