Provider Demographics
NPI:1083807580
Name:RAO, NANDINI LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDINI
Middle Name:LEE
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANDINI
Other - Middle Name:MARINA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:401 BICENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2149
Mailing Address - Country:US
Mailing Address - Phone:707-571-3778
Mailing Address - Fax:707-571-3799
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-571-3778
Practice Address - Fax:707-571-3799
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1110422084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry