Provider Demographics
NPI:1114711868
Name:PANDEY, PRATIK
Entity type:Individual
Prefix:
First Name:PRATIK
Middle Name:
Last Name:PANDEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N KELLEY AVE APT 233
Mailing Address - Street 2:630 N KELLEY AVE APT 233
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117
Mailing Address - Country:US
Mailing Address - Phone:405-209-3050
Mailing Address - Fax:
Practice Address - Street 1:630 N KELLEY AVE APT 233
Practice Address - Street 2:630 N KELLEY AVE APT 233
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117
Practice Address - Country:US
Practice Address - Phone:405-209-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program