Provider Demographics
NPI:1942881404
Name:OMADEVUAE, DIETANURUN BOSE
Entity type:Individual
Prefix:
First Name:DIETANURUN
Middle Name:BOSE
Last Name:OMADEVUAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIETANURUN
Other - Middle Name:BOSE
Other - Last Name:OMADEVUAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1092 ARLINGTON PLAZA
Mailing Address - Street 2:1724
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5028
Mailing Address - Country:US
Mailing Address - Phone:407-549-8320
Mailing Address - Fax:
Practice Address - Street 1:10920 MOSS PARK RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6086
Practice Address - Country:US
Practice Address - Phone:407-930-4339
Practice Address - Fax:407-745-1326
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities