Provider Demographics
NPI:1962378141
Name:IYER, SANJANA
Entity type:Individual
Prefix:
First Name:SANJANA
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17364 TEXAS PISTACHE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6531
Mailing Address - Country:US
Mailing Address - Phone:617-281-7274
Mailing Address - Fax:
Practice Address - Street 1:17364 TEXAS PISTACHE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6531
Practice Address - Country:US
Practice Address - Phone:617-281-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health