Provider Demographics
NPI:1760895262
Name:TABAJONDA, DHANA MAE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DHANA MAE
Middle Name:
Last Name:TABAJONDA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1401
Mailing Address - Country:US
Mailing Address - Phone:646-420-5568
Mailing Address - Fax:
Practice Address - Street 1:6200 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1409
Practice Address - Country:US
Practice Address - Phone:718-945-7150
Practice Address - Fax:718-318-4809
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY556029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse