Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT194036 | PA |
Y | 2080P0210X | Pediatric Nephrologist | 57521 | AZ |
NPI | 1619120607 |
---|---|
Provider Name | Anjali B Nayak |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
505991 | (05) | AZ |