Provider Demographics
NPI:1477091106
Name:MANDER, SUKHDEEP KAUR (NP)
Entity Type:Individual
Prefix:
First Name:SUKHDEEP
Middle Name:KAUR
Last Name:MANDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DATA BUSH DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-9476
Mailing Address - Country:US
Mailing Address - Phone:864-431-1653
Mailing Address - Fax:864-472-1850
Practice Address - Street 1:322 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1631
Practice Address - Country:US
Practice Address - Phone:864-431-1653
Practice Address - Fax:864-472-1850
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20460363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily