Provider Demographics
NPI:1477005742
Name:MEPPURATH, VIDYA (NP)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:MEPPURATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7134 260TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1151
Mailing Address - Country:US
Mailing Address - Phone:516-860-2122
Mailing Address - Fax:
Practice Address - Street 1:7134 260TH ST APT 1
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1151
Practice Address - Country:US
Practice Address - Phone:516-860-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307636-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health