Provider Demographics
NPI:1639309016
Name:MANDILAWI, NISREEN SADIQ (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NISREEN
Middle Name:SADIQ
Last Name:MANDILAWI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CADILLAC DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8350
Mailing Address - Country:US
Mailing Address - Phone:916-919-8066
Mailing Address - Fax:916-919-8066
Practice Address - Street 1:25 CADILLAC DR STE 104
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8350
Practice Address - Country:US
Practice Address - Phone:916-919-8066
Practice Address - Fax:916-919-8066
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY 24745103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program