Provider Demographics
NPI:1285717181
Name:PRASAD, ANITA (FNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:PRASAD
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 1:4418 E. RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589
Mailing Address - Country:US
Mailing Address - Phone:315-589-4641
Mailing Address - Fax:315-589-9585
Practice Address - Street 1:4418 E. RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589
Practice Address - Country:US
Practice Address - Phone:315-589-4641
Practice Address - Fax:315-589-9585
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334174363LF0000X
NYF3341741363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02629261Medicaid