Provider Demographics
NPI:1841019106
Name:SRIVASTAVA, PAYAL (FNP)
Entity type:Individual
Prefix:MRS
First Name:PAYAL
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4608
Mailing Address - Country:US
Mailing Address - Phone:917-239-7927
Mailing Address - Fax:516-366-1649
Practice Address - Street 1:520 FRANKLIN AVE STE 103
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5814
Practice Address - Country:US
Practice Address - Phone:516-280-3842
Practice Address - Fax:516-366-1649
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily