Provider Demographics
NPI:1861864928
Name:DIALA, DELIA
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:DIALA
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 1:97 SAINT NICHOLAS AVE
Mailing Address - Street 2:1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-3094
Mailing Address - Country:US
Mailing Address - Phone:917-602-6726
Mailing Address - Fax:
Practice Address - Street 1:97 SAINT NICHOLAS AVE
Practice Address - Street 2:1L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3094
Practice Address - Country:US
Practice Address - Phone:917-602-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY395560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse