Individual
SHAUNDA DIAMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
9805 63RD RD, 14J, REGO PARK, NY 11374-1744
(646) 280-6678
Mailing address
9805 63RD RD, 14J, REGO PARK, NY 11374-1744
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/27/2008
Last updated
02/27/2008
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