Provider Demographics
NPI:1396078861
Name:DAREDIA, NADIRSHAH NURDIN (RPH, MPH)
Entity type:Individual
Prefix:
First Name:NADIRSHAH
Middle Name:NURDIN
Last Name:DAREDIA
Suffix:
Gender:M
Credentials:RPH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 KNIGHTSBRIDGE RD
Mailing Address - Street 2:APT 2E
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4513
Mailing Address - Country:US
Mailing Address - Phone:516-708-1774
Mailing Address - Fax:516-708-1774
Practice Address - Street 1:360 E 193RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4710
Practice Address - Country:US
Practice Address - Phone:718-741-9505
Practice Address - Fax:718-741-9525
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045156183500000X
TX37750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist