Provider Demographics
NPI:1427414705
Name:MAHENDRA, VIJAITA
Entity Type:Individual
Prefix:
First Name:VIJAITA
Middle Name:
Last Name:MAHENDRA
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 1:9750 3RD AVE NE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2058
Mailing Address - Country:US
Mailing Address - Phone:206-535-8876
Mailing Address - Fax:
Practice Address - Street 1:9750 3RD AVE NE
Practice Address - Street 2:SUITE 305
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2058
Practice Address - Country:US
Practice Address - Phone:206-535-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-03
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst