Provider Demographics
NPI:1528227535
Name:NAYAK, RENUKA (PT)
Entity Type:Individual
Prefix:
First Name:RENUKA
Middle Name:
Last Name:NAYAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-491-9165
Mailing Address - Fax:
Practice Address - Street 1:2949 ERIE BLVD E
Practice Address - Street 2:SUITE 112
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1442
Practice Address - Country:US
Practice Address - Phone:315-251-1036
Practice Address - Fax:315-251-1039
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP64055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist