Provider Demographics
NPI:1720853138
Name:PANDEY, SINDHU N/A
Entity type:Individual
Prefix:
First Name:SINDHU
Middle Name:N/A
Last Name:PANDEY
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 1:236 E SOUTHFORK DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5422
Mailing Address - Country:US
Mailing Address - Phone:801-989-2628
Mailing Address - Fax:
Practice Address - Street 1:236 E SOUTHFORK DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5422
Practice Address - Country:US
Practice Address - Phone:801-989-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8897504-4405363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology