Provider Demographics
NPI:1710611546
Name:KHANDERIA, NIKITA (OT)
Entity Type:Individual
Prefix:MRS
First Name:NIKITA
Middle Name:
Last Name:KHANDERIA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 GRAND SONATA AVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5608
Mailing Address - Country:US
Mailing Address - Phone:609-480-9015
Mailing Address - Fax:
Practice Address - Street 1:5639 GRAND SONATA AVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5608
Practice Address - Country:US
Practice Address - Phone:609-480-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist