Provider Demographics
NPI:1598596942
Name:MANOCHA, SHREYA
Entity type:Individual
Prefix:
First Name:SHREYA
Middle Name:
Last Name:MANOCHA
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 1:771 TYLER ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4362
Mailing Address - Country:US
Mailing Address - Phone:713-855-1487
Mailing Address - Fax:
Practice Address - Street 1:200 ELM ST STE 2
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6551
Practice Address - Country:US
Practice Address - Phone:413-499-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist