Provider Demographics
NPI:1013028687
Name:PERSAUD, ANDREA NANDINI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NANDINI
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:215 EAST 95TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4007
Practice Address - Country:US
Practice Address - Phone:212-996-8000
Practice Address - Fax:212-423-3127
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY230268207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400161248Medicare PIN
NYI28274Medicare UPIN