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Individual

DIVYA VISWANATHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
100 WOODS RD, VALHALLA, NY 10595-1530
(914) 493-2363
Mailing address
19 BRADHURST AVE STE 3100N, HAWTHORNE, NY 10532-2140
(914) 909-9018
(914) 909-9028

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
023572
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
023572
NYS LICENSE
NY
Enumeration date
07/16/2019
Last updated
09/19/2019
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