Provider Demographics
NPI:1952293748
Name:CROSDALE, NADINE ANTOINETTE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:ANTOINETTE
Last Name:CROSDALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 RIVERDALE AVE UNIT 185
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-4307
Mailing Address - Country:US
Mailing Address - Phone:347-327-7244
Mailing Address - Fax:
Practice Address - Street 1:5951 RIVERDALE AVE UNIT 185
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-4307
Practice Address - Country:US
Practice Address - Phone:347-327-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14890363LP0808X
NY407244363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health