MEDICARE: HOSSIEN DAHDOULI APN

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	363L00000X	Nurse Practitioner	310921	NY
2	363LP2300X	Primary Care Nurse Practitioner	26NJ01361600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821719410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOSSIEN DAHDOULI APN

Provider Business Mailing Address
First Line	:	1776 WOODSTEAD CT STE 208
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1480
Country	:	US
Telephone Number	:	877-749-7428
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 LEXINGTON AVE
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1273
Country	:	US
Telephone Number	:	914-528-2000
Fax Number	:

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

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	12/02/2025

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