Provider Demographics
NPI:1245909753
Name:PRASAD, NANDKUMAR (RN)
Entity type:Individual
Prefix:MR
First Name:NANDKUMAR
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16224 JAMAICA AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4920
Mailing Address - Country:US
Mailing Address - Phone:718-657-2021
Mailing Address - Fax:
Practice Address - Street 1:16224 JAMAICA AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4920
Practice Address - Country:US
Practice Address - Phone:718-657-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY776570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse