Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 350524 | NY |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 382792 | NY |
NPI | 1114490356 |
---|---|
Provider Name | Maan Darisse Roxas Dayan |
First Address | Long Island City, NY 11103-3808 |
Second Address | Long Island City, NY 11103-3808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2019 |
Last Update Date | 12/03/2021 |