Provider Demographics
NPI:1609956473
Name:AUGELLI, DIANNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:MARIE
Last Name:AUGELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 61ST ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8722
Mailing Address - Country:US
Mailing Address - Phone:646-962-7378
Mailing Address - Fax:646-962-0455
Practice Address - Street 1:425 E 61ST ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8722
Practice Address - Country:US
Practice Address - Phone:646-962-7378
Practice Address - Fax:646-962-0455
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28077207R00000X, 2084P0800X
MO2010004018207RS0012X, 2084P0800X
NY273011207RS0012X, 2084P0800X, 207R00000X
NY280772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC281509Medicaid
MO1609956473Medicaid
MOW19000098Medicare PIN
SC281509Medicaid