Provider Demographics
NPI:1497005029
Name:FIDANI, ANANDA LYRA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANANDA
Middle Name:LYRA
Last Name:FIDANI
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23622 CALABASAS ROAD
Mailing Address - Street 2:SUITE 339
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1594
Mailing Address - Country:US
Mailing Address - Phone:818-225-0117
Mailing Address - Fax:818-225-0127
Practice Address - Street 1:23622 CALABASAS RD
Practice Address - Street 2:SUITE 339
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1549
Practice Address - Country:US
Practice Address - Phone:818-225-0117
Practice Address - Fax:818-225-0127
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22526363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical