Provider Demographics
NPI:1487029088
Name:MASSAND, PRIYA (MCHES, CLC)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:MASSAND
Suffix:
Gender:F
Credentials:MCHES, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WESTCHESTER AVE
Mailing Address - Street 2:1ST - ADMINISTRATION
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5072
Mailing Address - Country:US
Mailing Address - Phone:646-246-5303
Mailing Address - Fax:
Practice Address - Street 1:2300 WESTCHESTER AVE
Practice Address - Street 2:1ST - ADMINISTRATION
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5072
Practice Address - Country:US
Practice Address - Phone:646-246-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15568174H00000X
NY81051174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
15568OtherMCHES