Healthcare Provider Details

I. General information

NPI: 1558723759
Provider Name (Legal Business Name): NIKITA ROY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CHADBOURNE RD STE A
FAIRFIELD CA
94534-9620
US

IV. Provider business mailing address

1141 PEAR TREE LN
NAPA CA
94558-6484
US

V. Phone/Fax

Practice location:
  • Phone: 707-419-8989
  • Fax:
Mailing address:
  • Phone: 707-254-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC201006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number313713
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD467730
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: