Healthcare Provider Details

I. General information

NPI: 1255264784
Provider Name (Legal Business Name): NYANDA BOI BANGAY TRYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 5TH AVE STE 6115
NEW YORK NY
10118-6002
US

IV. Provider business mailing address

11332 204TH ST
SAINT ALBANS NY
11412-2535
US

V. Phone/Fax

Practice location:
  • Phone: 212-235-5043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number005083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: