MEDICARE: JULISSA AMANDA DABOIN

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	363LF0000X	Family Nurse Practitioner	345832	NY

General Provider Information

NPI Number	:	1942839436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULISSA AMANDA DABOIN

Provider Business Mailing Address
First Line	:	804 PALISADE AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10703-1521
Country	:	US
Telephone Number	:	914-217-0705
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 47TH AVE STE 635
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3433
Country	:	US
Telephone Number	:	718-472-1999
Fax Number	:

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

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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