Provider Demographics
NPI:1003538844
Name:SIDHU, MANDEEP KAUR (PMHNP)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11836 N 96TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5962
Mailing Address - Country:US
Mailing Address - Phone:480-798-4577
Mailing Address - Fax:
Practice Address - Street 1:4220 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5124
Practice Address - Country:US
Practice Address - Phone:623-872-1818
Practice Address - Fax:623-872-1819
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ281017363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty