Provider Demographics
NPI:1811528771
Name:OVERTON-TABB, DARIYAUNA
Entity type:Individual
Prefix:
First Name:DARIYAUNA
Middle Name:
Last Name:OVERTON-TABB
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 1:913 MARYVALE DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2701
Mailing Address - Country:US
Mailing Address - Phone:716-907-5175
Mailing Address - Fax:
Practice Address - Street 1:625 DELAWARE AVE STE 150
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1000
Practice Address - Country:US
Practice Address - Phone:716-884-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337599164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse