=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174784029
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYASREE NAIR F.N.P
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2008
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 GRASSLANDS RD
-----------------------------------------------------
City | VALHALLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10595-1652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-493-7494
-----------------------------------------------------
Fax | 914-493-7602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 TONI LN
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10710-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-779-0605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F333709-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------