Provider Demographics
NPI:1558006700
Name:WATERS, NASIRA TWAUNA
Entity Type:Individual
Prefix:MS
First Name:NASIRA
Middle Name:TWAUNA
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 S ORANGE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2255
Mailing Address - Country:US
Mailing Address - Phone:347-291-6008
Mailing Address - Fax:
Practice Address - Street 1:1909 LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4431
Practice Address - Country:US
Practice Address - Phone:347-497-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist