Provider Demographics
NPI:1942807136
Name:KANDAMKULATHY, ANSA SAJI (RN,CNN,FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANSA
Middle Name:SAJI
Last Name:KANDAMKULATHY
Suffix:
Gender:F
Credentials:RN,CNN,FNP-BC
Other - Prefix:
Other - First Name:ANSAMMA
Other - Middle Name:
Other - Last Name:SEBASTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,CNN
Mailing Address - Street 1:14 FINCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6311
Mailing Address - Country:US
Mailing Address - Phone:845-270-5081
Mailing Address - Fax:
Practice Address - Street 1:14 FINCH RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6311
Practice Address - Country:US
Practice Address - Phone:845-270-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily