Provider Demographics
NPI:1396367488
Name:KUDYAN, NIRVA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRVA
Middle Name:
Last Name:KUDYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1562
Mailing Address - Country:US
Mailing Address - Phone:716-348-3011
Mailing Address - Fax:
Practice Address - Street 1:124 FAIRFIELD STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2022
Practice Address - Country:US
Practice Address - Phone:917-620-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program