Provider Demographics
NPI:1811697733
Name:DIXON, NYDIA (DAC LAC)
Entity type:Individual
Prefix:
First Name:NYDIA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:DAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 HEMPSTEAD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2054
Mailing Address - Country:US
Mailing Address - Phone:516-968-1700
Mailing Address - Fax:
Practice Address - Street 1:314 HEMPSTEAD AVE STE 1
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2054
Practice Address - Country:US
Practice Address - Phone:516-968-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist