Provider Demographics
NPI:1215342076
Name:KHEHRA-MIRZAEI, SANDEEP (DPM)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:KHEHRA-MIRZAEI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18947 JOHN J WILLIAMS HWY UNIT 210
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4476
Mailing Address - Country:US
Mailing Address - Phone:302-645-3121
Mailing Address - Fax:302-645-3428
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY UNIT 210
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971
Practice Address - Country:US
Practice Address - Phone:302-645-3121
Practice Address - Fax:302-645-3428
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000244213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery