Provider Demographics
NPI:1457138992
Name:SONDHI, JAYATI DANIELLE (RBAI)
Entity Type:Individual
Prefix:
First Name:JAYATI
Middle Name:DANIELLE
Last Name:SONDHI
Suffix:
Gender:F
Credentials:RBAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 NW PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1409
Mailing Address - Country:US
Mailing Address - Phone:541-728-6969
Mailing Address - Fax:
Practice Address - Street 1:19800 VILLAGE OFFICE CT STE 103
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1813
Practice Address - Country:US
Practice Address - Phone:541-306-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10232035106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician