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General NPI Number Information
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NPI Number | 1629855614
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Entity Type | Individual
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Provider Name | D'ANDRA NASTASSIA RICHARDS
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Gender | Female
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 535 E 70TH ST # 7EAST
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City | NEW YORK
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State | NY
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Zip | 10021-4823
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Country | US
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Telephone | 917-502-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 492 HACKENSACK AVE APT 86
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2036
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Country | US
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Telephone | 917-502-2990
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F349989-01
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License Number State | NY
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