Provider Demographics
NPI:1700606332
Name:AVON BY BOSSY BEHAVIOR
Entity type:Organization
Organization Name:AVON BY BOSSY BEHAVIOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLEMAN DYKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD,DDSD,CCW
Authorized Official - Phone:415-477-1912
Mailing Address - Street 1:53 COLTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1247
Mailing Address - Country:US
Mailing Address - Phone:415-477-1912
Mailing Address - Fax:
Practice Address - Street 1:53 COLTON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1247
Practice Address - Country:US
Practice Address - Phone:415-477-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Multi-Specialty