Healthcare Provider Details

I. General information

NPI: 1235301870
Provider Name (Legal Business Name): NYLA RAJANI PERSAD M.ED CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL
BRONX NY
10461-2728
US

IV. Provider business mailing address

570 CONKLIN ST
FARMINGDALE NY
11735-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-4366
  • Fax: 718-863-9743
Mailing address:
  • Phone: 718-863-4366
  • Fax: 718-863-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: