Provider Demographics
NPI:1811198625
Name:MANCHANDANI, JYOTI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:
Last Name:MANCHANDANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WHITE CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1625
Mailing Address - Country:US
Mailing Address - Phone:631-662-9049
Mailing Address - Fax:
Practice Address - Street 1:37 WHITE CLIFF LN
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1625
Practice Address - Country:US
Practice Address - Phone:631-662-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP52678103TS0200X
NY017596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool