Provider Demographics
NPI:1689798001
Name:SAMANTARAY, MEENAKSHI (MD)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:SAMANTARAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S FAIROAKS AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-7913
Mailing Address - Country:US
Mailing Address - Phone:408-992-4800
Mailing Address - Fax:408-992-4801
Practice Address - Street 1:660 S FAIROAKS AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-7913
Practice Address - Country:US
Practice Address - Phone:408-992-4800
Practice Address - Fax:408-992-4801
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA416312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A416310Medicare PIN
F37872Medicare UPIN