Provider Demographics
NPI:1891680906
Name:THUTA, NYI
Entity type:Individual
Prefix:
First Name:NYI
Middle Name:
Last Name:THUTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MANSUR
Other - Middle Name:
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11854 SE POWELL BLVD APT 10
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1662
Mailing Address - Country:US
Mailing Address - Phone:310-910-2085
Mailing Address - Fax:
Practice Address - Street 1:11854 SE POWELL BLVD APT 10
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1662
Practice Address - Country:US
Practice Address - Phone:310-910-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker