| Doctor Name: | DIANE E BOARO |
| NPI Number: | 1427175348 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS., NPP |
| License Number: | F400809 |
| Business Practice Address: | 3771 Nesconset Hwy Suite 208b South Setauket, NY - 117201163 |
| Business Phone Number: | 6316892055 |
| Business Fax Number: | |
| Mailing Address: | 33 Cornell Ave, SMITHTOWN |
| State: | NY |
| Postal Code: | 117873403 |
| Phone Number: | 5167211976 |
| Fax Number: | |
| NPI Enumeration Date: | 03/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | F400809 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |