Provider Demographics
NPI:1770138380
Name:DALAL, RIYA AMIN (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:RIYA
Middle Name:AMIN
Last Name:DALAL
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 PARK EAST DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4309
Mailing Address - Country:US
Mailing Address - Phone:216-245-5680
Mailing Address - Fax:
Practice Address - Street 1:11716 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3002
Practice Address - Country:US
Practice Address - Phone:216-712-7818
Practice Address - Fax:216-712-7820
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041460259163W00000X
OHAPRN.CNP.0027012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse