Basic Information
Provider Information
NPI: 1952718108
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEMADE
FirstName: MONICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 222 E 34TH ST APT 1525
Address2:  
City: NEW YORK
State: NY
PostalCode: 100169840
CountryCode: US
TelephoneNumber: 2014676484
FaxNumber:  
Practice Location
Address1: 5352 LINTON BLVD
Address2:  
City: DELRAY BEACH
State: FL
PostalCode: 334846514
CountryCode: US
TelephoneNumber: 5614984440
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/21/2014
LastUpdateDate: 10/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X639961NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000XAPRN9450717FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
63996101NYNEW YORK STATE BOARD OF NURSINGOTHER


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