Provider Demographics
NPI:1831341858
Name:MAHER, PASSANG DIKI I (LPN)
Entity type:Individual
Prefix:MRS
First Name:PASSANG
Middle Name:DIKI
Last Name:MAHER
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PASSANG
Other - Middle Name:DIKI
Other - Last Name:MAHER
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:54 WAGON LN
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-6103
Mailing Address - Country:US
Mailing Address - Phone:845-282-1760
Mailing Address - Fax:845-282-1760
Practice Address - Street 1:208 HARRIS RD
Practice Address - Street 2:208 HARRIS RD
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-2125
Practice Address - Country:US
Practice Address - Phone:914-666-6854
Practice Address - Fax:914-666-6854
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274210-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse