Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 306728 | NY |
NPI | 1013544204 |
---|---|
Provider Name | Padmasri Dasari |
First Address | Roosevelt Island, NY 10044-0066 |
Second Address | Roosevelt Island, NY 10044-0066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |