Provider Demographics
NPI:1629668512
Name:PERSAUD, HOLLY MALANEE (NP, RN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MALANEE
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 E 72ND ST APT 3P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4052
Mailing Address - Country:US
Mailing Address - Phone:917-991-8775
Mailing Address - Fax:
Practice Address - Street 1:515 E 72ND ST APT 3P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4052
Practice Address - Country:US
Practice Address - Phone:917-991-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405116363LP0808X
NY310133363L00000X
NY678646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse