Provider Demographics
NPI:1215642350
Name:DICIERO, AVA ROSE MAI
Entity type:Individual
Prefix:
First Name:AVA ROSE
Middle Name:MAI
Last Name:DICIERO
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 1:3 STEPHEN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6138
Mailing Address - Country:US
Mailing Address - Phone:516-512-2354
Mailing Address - Fax:
Practice Address - Street 1:3 STEPHEN DR
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-6138
Practice Address - Country:US
Practice Address - Phone:516-512-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346279164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse