MEDICARE: DR. ILA DAYANANDA MD, MPH

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	207V00000X	Obstetrics & Gynecology Physician	235025	MA

General Provider Information

NPI Number	:	1558548446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILA DAYANANDA MD, MPH

Provider Business Mailing Address
First Line	:	109 MONTAGUE ST FL ST3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3437
Country	:	US
Telephone Number	:	718-400-8339
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 MONTAGUE ST FL ST3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3437
Country	:	US
Telephone Number	:	718-400-8339
Fax Number	:

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

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	11/25/2020

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