Healthcare Provider Details

I. General information

NPI: 1568395473
Provider Name (Legal Business Name): ANNA PARDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 W 85TH ST APT 3
NEW YORK NY
10024-4430
US

IV. Provider business mailing address

143 W 85TH ST APT 3
NEW YORK NY
10024-4430
US

V. Phone/Fax

Practice location:
  • Phone: 646-413-9768
  • Fax:
Mailing address:
  • Phone: 646-413-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number03227-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: