MEDICARE: DIANA DENIO PA-C

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
1	363A00000X	Physician Assistant	54018	CA
2	363A00000X	Physician Assistant		NY

General Provider Information

NPI Number	:	1659749455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA DENIO PA-C

Provider Business Mailing Address
First Line	:	29 WANDER CT
Second Line	:
City	:	GLENMONT
State	:	NY
Zip	:	12077-3523
Country	:	US
Telephone Number	:	518-669-2726
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 NEW SCOTLAND AVE
Second Line	:	MC-139
City	:	ALBANY
State	:	NY
Zip	:	12208-3412
Country	:	US
Telephone Number	:	518-262-3131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	12/22/2017

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Directions to “ DIANA DENIO PA-C” Practice Location

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