| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ROYA GANDT | 1023665924 | 2024-04-05 |
Roya Gandt is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1023665924. Registration indicates Roya Gandt is a provider of access to pediatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Neonatal, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Neonatal, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Roya Gandt NNP-BC |
| Other Provider Name | Roya Shahegh |
| Practice Office Address | 9000 W WISCONSIN AVE MILWAUKEE, WI US |
| Practice Office Telephone | 4142666820 |
| Practice Office Fax | 4142666979 |
| Mailing Address | 9000 W WISCONSIN AVE MILWAUKEE, WI 532264874 US |
| Business Telephone | 4142666820 |
| Business Fax | 4142666979 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 8915 W Connell Ave | Wauwatosa, WI 532263067 | 4142662000 |
| Code | Practice | License No State |
|---|---|---|
| 363LN0000X PRIMARY | Access to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Neonatal All Other Specialties & Provider Types Nurse Practitioner Neonatal Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 9593
WI |
| 1023665924 | MEDICAID | WI |