Provider Demographics
NPI:1316226749
Name:SUDBANTHAD, NATHAWAN PAMELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAWAN
Middle Name:PAMELA
Last Name:SUDBANTHAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:SUDBANTHAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:343 E 30TH ST
Mailing Address - Street 2:14K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6417
Mailing Address - Country:US
Mailing Address - Phone:212-213-8098
Mailing Address - Fax:
Practice Address - Street 1:343 E 30TH ST
Practice Address - Street 2:14K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6417
Practice Address - Country:US
Practice Address - Phone:212-213-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist