Provider Demographics
NPI:1093535411
Name:MANKODI, RAHOOL
Entity type:Individual
Prefix:
First Name:RAHOOL
Middle Name:
Last Name:MANKODI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 STONEY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7211
Mailing Address - Country:US
Mailing Address - Phone:561-358-5476
Mailing Address - Fax:
Practice Address - Street 1:6956 STONEY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7211
Practice Address - Country:US
Practice Address - Phone:561-358-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist