Provider Demographics
NPI:1225753445
Name:FERNANDO, SUBHASHINI Y
Entity Type:Individual
Prefix:
First Name:SUBHASHINI
Middle Name:Y
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2215
Mailing Address - Country:US
Mailing Address - Phone:801-310-6880
Mailing Address - Fax:
Practice Address - Street 1:200 N ANDERSON LN
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1110
Practice Address - Country:US
Practice Address - Phone:801-310-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker