Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401586-1 | NY |
NPI | 1023455995 |
---|---|
Provider Name | Nisha Pradeep |
First Address | Garden City Park, NY 11040-4134 |
Second Address | Jamaica, NY 11432-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2013 |
Last Update Date | 17/11/2014 |