Healthcare Provider Details

I. General information

NPI: 1821892548
Provider Name (Legal Business Name): NEHA VAZZALWAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-8434
US

IV. Provider business mailing address

101 NICOLLS RD
STONY BROOK NY
11794-8434
US

V. Phone/Fax

Practice location:
  • Phone: 631-216-9094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: