Provider Demographics
NPI:1154872216
Name:ROY, NITA (FNP)
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NITA
Other - Middle Name:
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5038
Mailing Address - Country:US
Mailing Address - Phone:646-318-9312
Mailing Address - Fax:
Practice Address - Street 1:59 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5038
Practice Address - Country:US
Practice Address - Phone:646-318-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341197275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit