Provider Demographics
NPI:1396181608
Name:CANALES, NADYA CLARISSA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:NADYA
Middle Name:CLARISSA
Last Name:CANALES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 SPRINGFIELD BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2023
Mailing Address - Country:US
Mailing Address - Phone:646-642-2404
Mailing Address - Fax:
Practice Address - Street 1:8709 SPRINGFIELD BLVD APT 2
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2023
Practice Address - Country:US
Practice Address - Phone:646-642-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY825681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist