Provider Demographics
NPI:1457501959
Name:WALIA, MAYAJIT DESIRE (ANP)
Entity Type:Individual
Prefix:
First Name:MAYAJIT
Middle Name:DESIRE
Last Name:WALIA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 AVENUE OF THE AMERICAS
Mailing Address - Street 2:16TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2787
Mailing Address - Country:US
Mailing Address - Phone:212-819-8561
Mailing Address - Fax:646-885-2217
Practice Address - Street 1:1155 AVENUE OF THE AMERICAS
Practice Address - Street 2:16TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2787
Practice Address - Country:US
Practice Address - Phone:212-819-8561
Practice Address - Fax:646-885-2217
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304095-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health