Provider Demographics
NPI:1902397003
Name:NARAYAN, ANJALI GIDICSIN (MD, MHA)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:GIDICSIN
Last Name:NARAYAN
Suffix:
Gender:F
Credentials:MD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MUD RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2231
Mailing Address - Country:US
Mailing Address - Phone:631-624-5424
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8101
Practice Address - Country:US
Practice Address - Phone:631-624-5424
Practice Address - Fax:631-444-7534
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314857-012084P0804X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry