Healthcare Provider Details

I. General information

NPI: 1104504075
Provider Name (Legal Business Name): NAMRITHA NARAYANA NAYAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST FL 3
SAN FRANCISCO CA
94115-3465
US

IV. Provider business mailing address

300 2ND AVE # SW209
LONG BRANCH NJ
07740-6395
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-6000
  • Fax:
Mailing address:
  • Phone: 732-923-7251
  • Fax: 732-923-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA209245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: