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General NPI Number Information
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NPI Number | 1194947085
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Entity Type | Individual
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Provider Name | DAWN M DIECIDUE NP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HIGHWAY BUILDING 23
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone | 631-246-9100
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Fax | 631-246-9156
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Provider Business Mailing Address
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Address Line | 7 EVERIT PLACE
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-724-5126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F420410
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License Number State | NY
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