Provider Demographics
NPI:1285836379
Name:GANDICA, RACHELLE GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:GRACE
Last Name:GANDICA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1150 ST. NICHOLAS AVE. 2ND FLOOR
Mailing Address - Street 2:NAOMI BERRIE DIABETES CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-851-5494
Mailing Address - Fax:212-851-5493
Practice Address - Street 1:1150 SAINT NICHOLAS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-851-5494
Practice Address - Fax:212-851-5493
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY241275-12080P0205X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400045971OtherMEDICARE ID
NY03395113Medicaid