MEDICARE: DR. NERAVANDA K MEDAPPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	111428	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952481673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NERAVANDA K MEDAPPA

Provider Business Mailing Address
First Line	:	65 MEDFORD RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3217
Country	:	US
Telephone Number	:	718-273-4367
Fax Number	:

Provider Business Practice Location Address
First Line	:	8662 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4102
Country	:	US
Telephone Number	:	718-714-6489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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