Provider Demographics
NPI:1538507124
Name:PERSAUD, INDRANI (DO)
Entity Type:Individual
Prefix:DR
First Name:INDRANI
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1420
Mailing Address - Country:US
Mailing Address - Phone:516-255-8414
Mailing Address - Fax:516-255-8450
Practice Address - Street 1:18803 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2511
Practice Address - Country:US
Practice Address - Phone:718-740-2060
Practice Address - Fax:718-740-4870
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine