Provider Demographics
NPI:1891255915
Name:MOHANTY, DIKSHA DEBASISH (MD)
Entity type:Individual
Prefix:DR
First Name:DIKSHA
Middle Name:DEBASISH
Last Name:MOHANTY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 4TH ST STE 232
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2324
Mailing Address - Country:US
Mailing Address - Phone:415-353-2311
Mailing Address - Fax:
Practice Address - Street 1:1651 4TH ST STE 232
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2324
Practice Address - Country:US
Practice Address - Phone:415-353-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1866732084N0400X
390200000X
NMMD2025-01482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program