Provider Demographics
NPI:1194712695
Name:MOHANTY, PRIYA D (MD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:D
Last Name:MOHANTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4498 MAIN ST
Mailing Address - Street 2:#23
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3826
Mailing Address - Country:US
Mailing Address - Phone:716-961-9938
Mailing Address - Fax:716-961-9910
Practice Address - Street 1:1020 YOUNGS ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-961-9900
Practice Address - Fax:716-961-9910
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224111207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
H50828Medicare UPIN