Provider Demographics
NPI:1396296455
Name:ROSADO, DHYALMA
Entity type:Individual
Prefix:
First Name:DHYALMA
Middle Name:
Last Name:ROSADO
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 1:2942 HONE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4014
Mailing Address - Country:US
Mailing Address - Phone:917-642-0942
Mailing Address - Fax:
Practice Address - Street 1:2942 HONE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4014
Practice Address - Country:US
Practice Address - Phone:917-642-0942
Practice Address - Fax:718-794-7445
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5964171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1245504935OtherINDIVIDUAL NPI NUMBER