Provider Demographics
NPI:1932512266
Name:DAO, MOHAMED D
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:D
Last Name:DAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W 195TH ST APT 1A
Mailing Address - Street 2:95 WEST 195TH STREET APT 1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2570
Mailing Address - Country:US
Mailing Address - Phone:347-375-4885
Mailing Address - Fax:
Practice Address - Street 1:95 WEST 195TH STREET APT 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:347-375-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6836243747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant