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General NPI Number Information
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NPI Number | 1790439297
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Entity Type | Individual
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Provider Name | DOROTHY ADHIAMB0 MAUNDA
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Gender | Female
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 84 WAVERLY ST
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City | POTSDAM
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State | NY
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Zip | 13676-1607
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Country | US
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Telephone | 315-261-3541
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Fax |
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Provider Business Mailing Address
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Address Line | 77 W BARNEY ST
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City | GOUVERNEUR
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State | NY
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Zip | 13642-1040
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Country | US
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Telephone | 315-287-1000
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F403984-01
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License Number State | NY
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