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General NPI Number Information
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NPI Number | 1679725626
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Entity Type | Individual
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Provider Name | KRISTAL SHIVANA PERSAUD RPA-C
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 111 EAST 210TH STREET MONTEFIORE MEDICAL CENTER
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City | BRONX
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State | NY
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Zip | 10467-2490
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Country | US
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Telephone | 718-920-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 WARING AVE
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City | BRONX
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State | NY
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Zip | 10469-5439
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Country | US
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Telephone | 646-245-0064
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 23 012865
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License Number State | NY
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