Provider Demographics
NPI:1407511207
Name:SADHRA, KIRANDEEP (SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:KIRANDEEP
Middle Name:
Last Name:SADHRA
Suffix:
Gender:F
Credentials:SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-932-6232
Practice Address - Street 1:20600 CHAGRIN BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5334
Practice Address - Country:US
Practice Address - Phone:216-295-7239
Practice Address - Fax:216-295-7240
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
OHS.2410941104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator