Healthcare Provider Details

I. General information

NPI: 1912519059
Provider Name (Legal Business Name): ANU VAZHAPPILLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 CENTRAL PARK AVE APT E3
SCARSDALE NY
10583-1363
US

IV. Provider business mailing address

356 CENTRAL PARK AVE APT E3
SCARSDALE NY
10583-1363
US

V. Phone/Fax

Practice location:
  • Phone: 914-202-5014
  • Fax:
Mailing address:
  • Phone: 914-202-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberF403078
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403078
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403078-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: