Provider Demographics
NPI:1326223421
Name:MOHARI, NIVEDITA (MBBS)
Entity Type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:
Last Name:MOHARI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 S CLIFF AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1009
Mailing Address - Country:US
Mailing Address - Phone:605-322-3666
Mailing Address - Fax:605-322-3665
Practice Address - Street 1:1417 S CLIFF AVE STE 201
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1009
Practice Address - Country:US
Practice Address - Phone:605-322-3666
Practice Address - Fax:605-322-3665
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD122682080P0203X
TXR59042080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine