Individual
NANDANEE MYNENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
824 ELIZABETH AVE, ELIZABETH, NJ 07201-4708
(908) 352-9556
Mailing address
600 PAVONIA AVE, JERSEY CITY, NJ 07306-2929
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00178400
NJ
Other
Enumeration date
04/20/2007
Last updated
05/19/2021
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