Provider Demographics
NPI:1770573081
Name:NAMASSIVAYA, DEVAYANI (MD)
Entity type:Individual
Prefix:DR
First Name:DEVAYANI
Middle Name:
Last Name:NAMASSIVAYA
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:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-0060
Mailing Address - Country:US
Mailing Address - Phone:315-624-6000
Mailing Address - Fax:315-624-4720
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-624-6000
Practice Address - Fax:315-624-4720
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219266-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098653Medicaid
NY02098653Medicaid