Provider Demographics
NPI:1275280869
Name:SANKHOLKAR, NIVEDITA V
Entity Type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:V
Last Name:SANKHOLKAR
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 1:10 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7425
Mailing Address - Country:US
Mailing Address - Phone:919-924-1960
Mailing Address - Fax:
Practice Address - Street 1:178 LOWELL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2719
Practice Address - Country:US
Practice Address - Phone:781-778-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist