Provider Demographics
NPI:1093496812
Name:NAYAK, RACHANA PRAKASH
Entity Type:Individual
Prefix:MS
First Name:RACHANA
Middle Name:PRAKASH
Last Name:NAYAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WINDING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9618
Mailing Address - Country:US
Mailing Address - Phone:610-670-4894
Mailing Address - Fax:
Practice Address - Street 1:922 NJ-35
Practice Address - Street 2:
Practice Address - City:OCEAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:848-217-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI02993500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program