Provider Demographics
NPI:1952148132
Name:DALIA, ANTONIETTA ANNA (PMHNP)
Entity type:Individual
Prefix:
First Name:ANTONIETTA
Middle Name:ANNA
Last Name:DALIA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANTONIETTA
Other - Middle Name:ANNA
Other - Last Name:DALIA-ADEWUNMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:67 PARK AVE UNIT ONE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603
Mailing Address - Country:US
Mailing Address - Phone:845-392-3267
Mailing Address - Fax:
Practice Address - Street 1:67 PARK AVE UNIT ONE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603
Practice Address - Country:US
Practice Address - Phone:845-392-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406152363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health