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General NPI Number Information
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NPI Number | 1306893201
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Entity Type | Individual
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Provider Name | SWAYAMPRABHA SADANANDAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 85 RADCLIFF AVE
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-1616
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Country | US
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Telephone | 718-250-6074
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Fax | 718-250-6518
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Provider Business Mailing Address
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Address Line | 85 RADCLIFF AVE
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-1616
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Country | US
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Telephone | 718-250-6074
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Fax | 718-250-6518
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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 | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 137345
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License Number State | NY
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