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1942881404 NPI number — DIETANURUN BOSE OMADEVUAE

NPI Number: 1942881404
Health Care Provider/Practitioner: DIETANURUN BOSE OMADEVUAE

Information about “1942881404” NPI (DIETANURUN BOSE OMADEVUAE) exists in 1942881404 in HTML format HTML  |  1942881404 in plain Text format TXT  |  1942881404 in PDF (Portable Document Format) PDF  |  1942881404 in an XML format XML  formats.

NPI Number : 1942881404 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942881404",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OMADEVUAE",
    "FirstName": "DIETANURUN",
    "MiddleName": "BOSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "OMADEVUAE",
    "OtherFirstName": "DIETANURUN",
    "OtherMiddleName": "BOSE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1092 ARLINGTON PLAZA",
    "SecondLineMailingAddress": "1724",
    "MailingAddressCityName": "OMAHA",
    "MailingAddressStateName": "NE",
    "MailingAddressPostalCode": "68164-5028",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-549-8320",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10920 MOSS PARK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ORLANDO",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32832-6086",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-930-4339",
    "PracticeLocationAddressFaxNumber": "407-745-1326",
    "EnumerationDate": "04/16/2021",
    "LastUpdateDate": "05/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320900000X",
        "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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