Provider Demographics
NPI:1154665404
Name:DU, DIYAH
Entity Type:Individual
Prefix:MS
First Name:DIYAH
Middle Name:
Last Name:DU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DBA MINT
Other - Middle Name:
Other - Last Name:CONDITION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1856 N NOB HILL RD
Mailing Address - Street 2:# 317
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6548
Mailing Address - Country:US
Mailing Address - Phone:954-444-2659
Mailing Address - Fax:
Practice Address - Street 1:1856 N NOB HILL RD
Practice Address - Street 2:# 317
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6548
Practice Address - Country:US
Practice Address - Phone:954-444-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29514171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor