Individual
PRANVERA DERVISHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1334 ASTOR AVE, PVH 2ND FLOOR, BRONX, NY 10469-5832
(646) 703-2048
Mailing address
1334 ASTOR AVE, PVH 2ND FLOOR, BRONX, NY 10469-5832
(646) 703-2048
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
018011
NY
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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