Provider Demographics
NPI:1760008270
Name:ALDORA INJURY AND WELLNESS PLLC
Entity Type:Organization
Organization Name:ALDORA INJURY AND WELLNESS PLLC
Other - Org Name:ALDORA INJURY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:VIVAKSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDURI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:425-610-9394
Mailing Address - Street 1:4580 KLAHANIE DR SE # 197
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5812
Mailing Address - Country:US
Mailing Address - Phone:425-610-9394
Mailing Address - Fax:
Practice Address - Street 1:3005 ALDERWOOD MALL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6921
Practice Address - Country:US
Practice Address - Phone:425-610-9394
Practice Address - Fax:833-418-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Multi-Specialty