Provider Demographics
NPI:1598254419
Name:DIRAIMONDO, NORA (AGNP-C)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:DIRAIMONDO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:
Other - Last Name:WYLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:SB HOSPITAL 101 NICOLLS ROAD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SB HOSPITAL 101 NICOLLS ROAD
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-263-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308390363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health