Provider Demographics
NPI:1013413400
Name:NANDIVADA, NAGENDRANATH
Entity Type:Individual
Prefix:DR
First Name:NAGENDRANATH
Middle Name:
Last Name:NANDIVADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 FIELDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3275
Mailing Address - Country:US
Mailing Address - Phone:718-370-3076
Mailing Address - Fax:718-370-3076
Practice Address - Street 1:113 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3275
Practice Address - Country:US
Practice Address - Phone:718-370-3076
Practice Address - Fax:718-370-3076
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator