Provider Demographics
NPI:1689859936
Name:UPADHYAY, AMITA MANISH (MD, MPH)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:MANISH
Last Name:UPADHYAY
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Gender:F
Credentials:MD, MPH
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:508 GIBSON DRIVE
Mailing Address - Street 2:SUITE 270 A
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5795
Mailing Address - Country:US
Mailing Address - Phone:916-771-4747
Mailing Address - Fax:916-771-4745
Practice Address - Street 1:508 GIBSON DRIVE
Practice Address - Street 2:SUITE 270 A
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5795
Practice Address - Country:US
Practice Address - Phone:916-771-4747
Practice Address - Fax:916-771-4745
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2021-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1003682084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry