Individual
NISHA MANOJ GHAYALOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
44360 COUNTY ROAD 48, SOUTHOLD, NY 11971-5033
(631) 734-8742
Mailing address
44360 COUNTY ROAD 48, SOUTHOLD, NY 11971-5033
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
1017323
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2021
Last updated
11/18/2025
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