Provider Demographics
NPI:1770169435
Name:PRESCOD, NYRA MICHELLE
Entity type:Individual
Prefix:
First Name:NYRA
Middle Name:MICHELLE
Last Name:PRESCOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3930
Mailing Address - Country:US
Mailing Address - Phone:718-598-4546
Mailing Address - Fax:
Practice Address - Street 1:2553 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3930
Practice Address - Country:US
Practice Address - Phone:718-598-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109994104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker