Provider Demographics
NPI:1275165227
Name:GREWAL, SANDEEP
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 COLBY AVE STE 328
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3531
Mailing Address - Country:US
Mailing Address - Phone:425-740-3600
Mailing Address - Fax:
Practice Address - Street 1:2722 COLBY AVE STE 328
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3531
Practice Address - Country:US
Practice Address - Phone:425-740-3600
Practice Address - Fax:425-740-3601
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61123582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health