Individual
PRASHANT PENDYALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
53 ELIZABETH DR, LOCKPORT, NY 14094-5226
(716) 650-0373
Mailing address
50 SANCTUARY CT, BUFFALO, NY 14221-3963
(716) 912-9595
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
001535
NY
207RN0300X
Nephrology Physician
Primary
241265
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02212706
—
NY
Enumeration date
05/25/2006
Last updated
03/14/2021
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