Provider Demographics
NPI:1346887981
Name:DEWAN, MONIKA MARIA (RN)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:MARIA
Last Name:DEWAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5142
Mailing Address - Country:US
Mailing Address - Phone:518-584-3600
Mailing Address - Fax:
Practice Address - Street 1:30 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5142
Practice Address - Country:US
Practice Address - Phone:518-584-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405055363LP0808X
NY532041163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool