Provider Demographics
NPI:1417656265
Name:BANGALORE SHYAM SUNDAR, DIVYA I
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:BANGALORE SHYAM SUNDAR
Suffix:I
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 1:3575 MONROE ST APT 204
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7762
Mailing Address - Country:US
Mailing Address - Phone:408-329-3272
Mailing Address - Fax:
Practice Address - Street 1:3575 MONROE ST APT 204
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-7762
Practice Address - Country:US
Practice Address - Phone:408-329-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician