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General NPI Number Information
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NPI Number | 1396435442
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Entity Type | Individual
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Provider Name | DIADO SOW
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Gender | Female
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 26 DUMONT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1450
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Country | US
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Telephone | 718-667-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 2280 GRAND AVE APT 3H
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City | BRONX
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State | NY
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Zip | 10468-6978
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Country | US
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Telephone |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 345747
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 345747
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 345747
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License Number State | NY
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