Provider Demographics
NPI:1487760195
Name:PANDYA, HEENA DIPAK (MD)
Entity type:Individual
Prefix:
First Name:HEENA
Middle Name:DIPAK
Last Name:PANDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEENA
Other - Middle Name:YOGENDRA
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3010 GRAND AVE
Mailing Address - Street 2:CHILD AND ADOLESCENT BEHAVIORAL SERVICES
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-377-8950
Mailing Address - Fax:414-266-3735
Practice Address - Street 1:3010 GRAND AVE
Practice Address - Street 2:CHILD AND ADOLESCENT BEHAVIORAL SERVICES
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-377-8950
Practice Address - Fax:414-266-3735
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000453012084P0800X
WI51660-202084P0804X
IL0361199052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry