Provider Demographics
NPI:1902121312
Name:MUTYAVAIRI, TEERERAI PRECIOUS (NP)
Entity Type:Individual
Prefix:MRS
First Name:TEERERAI
Middle Name:PRECIOUS
Last Name:MUTYAVAIRI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-2937
Mailing Address - Country:US
Mailing Address - Phone:518-436-4462
Mailing Address - Fax:518-436-4558
Practice Address - Street 1:175 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2937
Practice Address - Country:US
Practice Address - Phone:518-436-4462
Practice Address - Fax:518-436-4558
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015962363LP0808X
NY497238-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult