Provider Demographics
NPI:1932405479
Name:MODY, NEHA A (PA)
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:A
Last Name:MODY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 WALNUT ST
Mailing Address - Street 2:9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5176
Mailing Address - Country:US
Mailing Address - Phone:215-829-8713
Mailing Address - Fax:215-829-5350
Practice Address - Street 1:800 WALNUT ST FL 9
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5176
Practice Address - Country:US
Practice Address - Phone:215-829-8713
Practice Address - Fax:215-829-5350
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA059320363AS0400X
VA0110003490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant