Provider Demographics
NPI:1720303894
Name:DIVAKARAN, MARIAMMA DANIEL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIAMMA
Middle Name:DANIEL
Last Name:DIVAKARAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 CHAMBERLIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3809
Mailing Address - Country:US
Mailing Address - Phone:516-485-3541
Mailing Address - Fax:
Practice Address - Street 1:15011 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3319
Practice Address - Country:US
Practice Address - Phone:718-739-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3854406164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse