Healthcare Provider Details

I. General information

NPI: 1295684231
Provider Name (Legal Business Name): KIRAN PAYYADI RAMAPRASAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 09/29/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61-22G FRESH POND RD MIDDLE VILLAGE
NEW YORK NY
11379
US

IV. Provider business mailing address

61-22G FRESH POND RD MIDDLE VILLAGE
NEW YORK NY
11379
US

V. Phone/Fax

Practice location:
  • Phone: 718-685-2300
  • Fax:
Mailing address:
  • Phone: 718-685-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360906
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number950213
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: