Provider Demographics
NPI:1225369093
Name:PLEMMONS, DIAWANTI
Entity Type:Individual
Prefix:
First Name:DIAWANTI
Middle Name:
Last Name:PLEMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 N MAIN ST
Mailing Address - Street 2:BUILDING B-UNIT 5
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:339 N MAIN ST
Practice Address - Street 2:BUILDING B-UNIT 5
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4300
Practice Address - Country:US
Practice Address - Phone:845-638-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467766-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health