Provider Demographics
NPI:1154911659
Name:DARAMY, MARIAMA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARIAMA
Middle Name:
Last Name:DARAMY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SPRINGDALE ROAD
Mailing Address - Street 2:CLINIC #01146
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3904
Mailing Address - Country:US
Mailing Address - Phone:856-428-5909
Mailing Address - Fax:
Practice Address - Street 1:101 SPRINGDALE ROAD
Practice Address - Street 2:CLINIC # 01146
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:862-703-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01099200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty