Provider Demographics
NPI:1215498373
Name:SANDHU, SIMRATDEEP KAUR
Entity type:Individual
Prefix:
First Name:SIMRATDEEP
Middle Name:KAUR
Last Name:SANDHU
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 1:1073 SARAH ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2861
Mailing Address - Country:US
Mailing Address - Phone:469-601-8329
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVE SE FL 5
Practice Address - Street 2:BEHAVIORAL MEDICINE AND PSYCHIATRY
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-1000
Practice Address - Fax:304-388-1041
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012805792084P0800X
WV321612084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program