MEDICARE: MISS NADIA P PERSAUD RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	007436-1	NY

General Provider Information

NPI Number	:	1043474794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NADIA P PERSAUD RPA-C

Provider Business Mailing Address
First Line	:	150 55TH ST
Second Line	:	RM 4823- 4TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2559
Country	:	US
Telephone Number	:	718-630-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 55TH STREET
Second Line	:	RM 4823-4TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2324
Country	:	US
Telephone Number	:	718-630-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	06/05/2023

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