Healthcare Provider Details

I. General information

NPI: 1538102710
Provider Name (Legal Business Name): USHA AVVA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MIDLAND AVE
NYACK NY
10960-1912
US

IV. Provider business mailing address

549 BURLINGTON ST
PARAMUS NJ
07652-5603
US

V. Phone/Fax

Practice location:
  • Phone: 845-348-2886
  • Fax:
Mailing address:
  • Phone: 201-483-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMA06177700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number197583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: