Provider Demographics
NPI:1619668001
Name:MANSARAY, TIGIDANKAY
Entity Type:Individual
Prefix:
First Name:TIGIDANKAY
Middle Name:
Last Name:MANSARAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIGIDANKAY
Other - Middle Name:
Other - Last Name:MANSARAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 GROVE TER
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-2049
Mailing Address - Country:US
Mailing Address - Phone:317-529-2975
Mailing Address - Fax:
Practice Address - Street 1:106 GROVE TER
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-2049
Practice Address - Country:US
Practice Address - Phone:375-529-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health