Healthcare Provider Details

I. General information

NPI: 1154205680
Provider Name (Legal Business Name): YADU NANDA SUBEDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 WOODYCREST AVE
BRONX NY
10452-5503
US

IV. Provider business mailing address

5804 STONE GATE HTS APT 2
JAMESVILLE NY
13078-4507
US

V. Phone/Fax

Practice location:
  • Phone: 718-414-1750
  • Fax:
Mailing address:
  • Phone: 901-340-2943
  • Fax:

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 Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP137465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: