Provider Demographics
NPI:1699017046
Name:NAIR, NISHA G (PA-C)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:G
Last Name:NAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-5023
Mailing Address - Country:US
Mailing Address - Phone:617-671-5562
Mailing Address - Fax:
Practice Address - Street 1:BOSTON VA HEALTHCARE SYSTEM
Practice Address - Street 2:150S HUNTINGTON AVE,
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:857-203-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4657363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical