Individual
DIANA FISSIDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(215) 456-7890
Mailing address
101 E OLNEY AVE STE 400, PHILADELPHIA, PA 19120-2470
(215) 456-1825
(215) 456-5926
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
SP030017
PA
Other
Enumeration date
07/30/2024
Last updated
09/21/2024
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