Provider Demographics
NPI:1679956072
Name:KHANDELWAL, AMISHI (PA)
Entity Type:Individual
Prefix:
First Name:AMISHI
Middle Name:
Last Name:KHANDELWAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 DALE AVE
Mailing Address - Street 2:APT 20
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3368
Mailing Address - Country:US
Mailing Address - Phone:773-655-2410
Mailing Address - Fax:
Practice Address - Street 1:1240 DALE AVE
Practice Address - Street 2:APT 20
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3368
Practice Address - Country:US
Practice Address - Phone:773-655-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant