Provider Demographics
NPI:1346415197
Name:PERSAUD, MINERA DEVI
Entity Type:Individual
Prefix:MRS
First Name:MINERA
Middle Name:DEVI
Last Name:PERSAUD
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 1:155 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4766
Mailing Address - Country:US
Mailing Address - Phone:212-683-3042
Mailing Address - Fax:917-351-3669
Practice Address - Street 1:85 BUCKNELL RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5326
Practice Address - Country:US
Practice Address - Phone:516-972-6637
Practice Address - Fax:516-972-6637
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0044225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist