Provider Demographics
NPI:1730067174
Name:VIRK-BAKER, MANDEEP (PHD, MPH, RD)
Entity type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:VIRK-BAKER
Suffix:
Gender:F
Credentials:PHD, MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:WEST ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13861-0158
Mailing Address - Country:US
Mailing Address - Phone:607-663-0810
Mailing Address - Fax:
Practice Address - Street 1:3146 STATE HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:WEST ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13861-6908
Practice Address - Country:US
Practice Address - Phone:607-663-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNDP-2025-0065133V00000X
86052465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered