MEDICARE: MS. DIANA CALLESANO AU.D.

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	231H00000X	Audiologist	002531	NY
2	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1710394127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA CALLESANO AU.D.

Provider Business Mailing Address
First Line	:	113 CROSSWAYS PARK DR
Second Line	:	SUITE 101
City	:	WOODBURY
State	:	NY
Zip	:	11797-2044
Country	:	US
Telephone Number	:	516-364-0011
Fax Number	:	516-364-0013

Provider Business Practice Location Address
First Line	:	113 CROSSWAYS PARK DR
Second Line	:	SUITE 101
City	:	WOODBURY
State	:	NY
Zip	:	11797-2044
Country	:	US
Telephone Number	:	516-364-0011
Fax Number	:	516-364-0013

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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