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General NPI Number Information
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NPI Number | 1124185848
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Entity Type | Individual
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Provider Name | SHARDA PERSAUD R.P.A-C.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 4802 10TH AVE MAIMONIDES MEDICAL CENTER, DEPT. OF NEUROSURGERY
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City | BROOKLYN
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State | NY
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Zip | 11219-2916
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Country | US
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Telephone | 718-283-7219
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Fax |
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Provider Business Mailing Address
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Address Line | 231 E 76TH ST APT. 7D
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City | NEW YORK
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State | NY
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Zip | 10021-2134
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Country | US
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Telephone | 646-334-3174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 006284
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License Number State | NY
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