Provider Demographics
NPI:1205991551
Name:NANDI, PRIYA SHANKAR (MD)
Entity type:Individual
Prefix:MR
First Name:PRIYA
Middle Name:SHANKAR
Last Name:NANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 BLUEBERRY LANE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090
Mailing Address - Country:US
Mailing Address - Phone:781-769-7575
Mailing Address - Fax:781-769-7535
Practice Address - Street 1:2 ADAMS PLACE
Practice Address - Street 2:SUITE 405
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7456
Practice Address - Country:US
Practice Address - Phone:781-939-3500
Practice Address - Fax:981-939-3570
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA35191208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
035191OtherTUFTS HEALTH PLAN
MA2030039Medicaid
6102OtherHARVARD PILGRIM
035191OtherTUFTS HEALTH PLAN
A53764Medicare UPIN