Provider Demographics
NPI:1790807410
Name:NAMASSIVAYA, ARUNDATHI (MD)
Entity Type:Individual
Prefix:
First Name:ARUNDATHI
Middle Name:
Last Name:NAMASSIVAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 SWEET HOME RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2792
Mailing Address - Country:US
Mailing Address - Phone:716-838-3188
Mailing Address - Fax:716-838-1297
Practice Address - Street 1:1306 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2792
Practice Address - Country:US
Practice Address - Phone:716-838-3188
Practice Address - Fax:716-838-1297
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217755207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098662Medicaid
NY02098662Medicaid