Provider Demographics
NPI:1356331599
Name:KAYASTHA, VEENA (MD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:KAYASTHA
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 1:600 E GENESEE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3130
Mailing Address - Country:US
Mailing Address - Phone:315-474-7735
Mailing Address - Fax:315-474-7433
Practice Address - Street 1:600 E GENESEE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3130
Practice Address - Country:US
Practice Address - Phone:315-474-7735
Practice Address - Fax:315-474-7433
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1388522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00689496Medicaid
NY38705BMedicare ID - Type Unspecified
B82162Medicare UPIN