Provider Demographics
NPI:1336309814
Name:SUKHTANKAR, MEGHANA
Entity Type:Individual
Prefix:
First Name:MEGHANA
Middle Name:
Last Name:SUKHTANKAR
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 1:2675 STEVENSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2323
Mailing Address - Country:US
Mailing Address - Phone:510-794-5800
Mailing Address - Fax:510-790-1102
Practice Address - Street 1:2675 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2323
Practice Address - Country:US
Practice Address - Phone:510-794-5800
Practice Address - Fax:510-790-1102
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAR534YMedicare PIN