Provider Demographics
NPI:1710407325
Name:RAJINIKANTH, MONISHA (OD)
Entity Type:Individual
Prefix:
First Name:MONISHA
Middle Name:
Last Name:RAJINIKANTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BORTHWICK AVE STE 200E
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4184
Mailing Address - Country:US
Mailing Address - Phone:603-436-1773
Mailing Address - Fax:603-427-0655
Practice Address - Street 1:155 BORTHWICK AVE # 200
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7156
Practice Address - Country:US
Practice Address - Phone:603-436-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3110591Medicaid