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General NPI Number Information
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NPI Number | 1710122767
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Entity Type | Individual
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Provider Name | SI YAN DIANA DOU RPA-C
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Gender | Female
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 79 E RAILROAD AVE
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City | JAMESBURG
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State | NJ
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Zip | 08831-1207
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Country | US
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Telephone | 732-561-8555
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Fax | 732-561-1165
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Provider Business Mailing Address
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Address Line | 322 WILLOW WINDS PKWY
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City | SAINT JOHNS
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State | FL
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Zip | 32259-7268
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 013054
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP001414400
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License Number State | NJ
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