Provider Demographics
NPI:1194548024
Name:KAVYA MOHANDAS, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:KAVYA MOHANDAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAVYA MOHANDAS
Other - Middle Name:
Other - Last Name:LNU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:71 ENGLEWOOD AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1234
Mailing Address - Country:US
Mailing Address - Phone:425-370-7425
Mailing Address - Fax:
Practice Address - Street 1:245 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2973
Practice Address - Country:US
Practice Address - Phone:646-841-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist