Provider Demographics
NPI:1689910747
Name:PRADHAN, AMYNAH (NP)
Entity Type:Individual
Prefix:
First Name:AMYNAH
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DR BLDG 10
Mailing Address - Street 2:ROOM 13C429A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1908
Mailing Address - Country:US
Mailing Address - Phone:301-402-1474
Mailing Address - Fax:301-496-5370
Practice Address - Street 1:10 CENTER DR BLDG 10
Practice Address - Street 2:ROOM 13C429A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1908
Practice Address - Country:US
Practice Address - Phone:301-402-1474
Practice Address - Fax:301-496-5370
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily