Provider Demographics
NPI:1437598562
Name:WADHVANIA, NILAM (PA-C)
Entity Type:Individual
Prefix:
First Name:NILAM
Middle Name:
Last Name:WADHVANIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 60TH RD APT 4C
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5516
Mailing Address - Country:US
Mailing Address - Phone:347-456-4406
Mailing Address - Fax:
Practice Address - Street 1:510 HEMPSTEAD TPKE RM 203
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1152
Practice Address - Country:US
Practice Address - Phone:516-505-7200
Practice Address - Fax:949-419-3482
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016205363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical