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NPI Code Detail

MEDICARE: MRS. KEISHA DIAZ

MEDICARE: MRS. KEISHA DIAZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool PsychologistNY

General Provider Information

NPI Number : 1366298382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KEISHA DIAZ
Provider Business Mailing Address
First Line : 1311 MAMARONECK AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5221
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1311 MAMARONECK AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5221
Country : US
Telephone Number : 914-328-2868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2024
Last Update Date : 04/29/2024

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Directions to “ MRS. KEISHA DIAZ ” Practice Location

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