Provider Demographics
NPI:1164313094
Name:NALLADURAI, ABISHA NANCY (OD)
Entity type:Individual
Prefix:
First Name:ABISHA
Middle Name:NANCY
Last Name:NALLADURAI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14619 61ST RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1203
Mailing Address - Country:US
Mailing Address - Phone:917-496-1662
Mailing Address - Fax:
Practice Address - Street 1:25 WESTCHESTER SQ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3545
Practice Address - Country:US
Practice Address - Phone:718-597-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist