Provider Demographics
NPI:1437564119
Name:DURAN, YOMIRA
Entity Type:Individual
Prefix:
First Name:YOMIRA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8412 35TH AVE
Mailing Address - Street 2:4H
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5453
Mailing Address - Country:US
Mailing Address - Phone:718-598-3278
Mailing Address - Fax:
Practice Address - Street 1:8412 35TH AVE
Practice Address - Street 2:4H
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5453
Practice Address - Country:US
Practice Address - Phone:718-598-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist