Provider Demographics
NPI:1114131331
Name:VASISHTA, SANDEEP (OTR)
Entity Type:Individual
Prefix:MR
First Name:SANDEEP
Middle Name:
Last Name:VASISHTA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BEAVER VALLEY CV S
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7724
Mailing Address - Country:US
Mailing Address - Phone:901-759-1617
Mailing Address - Fax:800-781-4548
Practice Address - Street 1:116 BEAVER VALLEY CV S
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7724
Practice Address - Country:US
Practice Address - Phone:901-759-1617
Practice Address - Fax:800-781-4548
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000001341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist