Basic Information
Provider Information | |||||||||
NPI: | 1891787735 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NAYAK | ||||||||
FirstName: | SHAILA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4567 CROSSROADS PARK DR | ||||||||
Address2: | 2ND FLOOR | ||||||||
City: | LIVERPOOL | ||||||||
State: | NY | ||||||||
PostalCode: | 130883589 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3152952100 | ||||||||
FaxNumber: | 3152952125 | ||||||||
Practice Location | |||||||||
Address1: | 355 GRAND ST | ||||||||
Address2: |   | ||||||||
City: | JERSEY CITY | ||||||||
State: | NJ | ||||||||
PostalCode: | 073024321 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2019152485 | ||||||||
FaxNumber: | 2019152377 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/17/2005 | ||||||||
LastUpdateDate: | 11/21/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | 25MA03238600 | NJ | N |   | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZP0102X | 25MA03238600 | NJ | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.