Provider Demographics
NPI:1376306084
Name:NAIR, DIVYA SURENDRAN (PA)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:SURENDRAN
Last Name:NAIR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DIVYA
Other - Middle Name:SURENDRAN
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:160 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1741
Mailing Address - Country:US
Mailing Address - Phone:516-462-3707
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical