Provider Demographics
NPI:1235510405
Name:MAHATO, BISUNDEV (MD)
Entity Type:Individual
Prefix:DR
First Name:BISUNDEV
Middle Name:
Last Name:MAHATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W SUNSET BLVD # 1072
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7315
Mailing Address - Country:US
Mailing Address - Phone:833-466-4589
Mailing Address - Fax:845-286-1936
Practice Address - Street 1:6450 W SUNSET BLVD # 1072
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-7315
Practice Address - Country:US
Practice Address - Phone:833-466-4589
Practice Address - Fax:845-286-1936
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-14
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1489462084P0800X
NY3107132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry