Provider Demographics
NPI:1427644962
Name:DIUBALDO, PHYLLIS ELIZABETH
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ELIZABETH
Last Name:DIUBALDO
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 1:421 HAMMOND ST APT 305
Mailing Address - Street 2:
Mailing Address - City:WESTERNPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21562-1224
Mailing Address - Country:US
Mailing Address - Phone:301-359-9274
Mailing Address - Fax:
Practice Address - Street 1:421 HAMMOND ST APT 305
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-1224
Practice Address - Country:US
Practice Address - Phone:301-359-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant