Provider Demographics
NPI:1417727983
Name:SANGHDEEP, SUMEDH
Entity Type:Individual
Prefix:
First Name:SUMEDH
Middle Name:
Last Name:SANGHDEEP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2506
Mailing Address - Country:US
Mailing Address - Phone:951-775-2456
Mailing Address - Fax:
Practice Address - Street 1:6711 ARLINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1966
Practice Address - Country:US
Practice Address - Phone:951-352-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist