Provider Demographics
NPI:1336186758
Name:VALADA, VIDYA (MD)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:VALADA
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 1:35 SUTTON PL # 12D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2429
Mailing Address - Country:US
Mailing Address - Phone:347-351-3315
Mailing Address - Fax:212-755-0110
Practice Address - Street 1:580 PARK AVE APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7342
Practice Address - Country:US
Practice Address - Phone:212-755-0037
Practice Address - Fax:212-755-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY48C341Medicare PIN
NYG87866Medicare UPIN