Provider Demographics
NPI:1356815864
Name:PANDYA, PRIYANKA J (NP)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:J
Last Name:PANDYA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PRIYANKA
Other - Middle Name:J
Other - Last Name:TRIVEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6600 BLVD E APT AD
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4218
Mailing Address - Country:US
Mailing Address - Phone:347-845-1301
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350451-1363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF350451-1OtherNURSE PRACTITIONER LICENSE