Provider Demographics
NPI:1487386397
Name:NANDLAL, VIDYA SARAH (DO)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:SARAH
Last Name:NANDLAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 MONTAUK HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4939
Mailing Address - Country:US
Mailing Address - Phone:631-422-9600
Mailing Address - Fax:631-422-9697
Practice Address - Street 1:1175 MONTAUK HWY STE 4
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4939
Practice Address - Country:US
Practice Address - Phone:631-422-9600
Practice Address - Fax:631-422-9697
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics