Provider Demographics
NPI:1386097111
Name:BANDONG, LYZA TRINIDAD
Entity type:Individual
Prefix:MISS
First Name:LYZA TRINIDAD
Middle Name:
Last Name:BANDONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E 90TH ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5173
Mailing Address - Country:US
Mailing Address - Phone:646-284-8891
Mailing Address - Fax:
Practice Address - Street 1:417 E 90TH ST APT 7B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5173
Practice Address - Country:US
Practice Address - Phone:646-284-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF431016 -1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care