Provider Demographics
NPI:1659110856
Name:SHAKTIROOPANANDA, NITHYA
Entity type:Individual
Prefix:
First Name:NITHYA
Middle Name:
Last Name:SHAKTIROOPANANDA
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 1:800 BONAVENTURE WAY STE 122
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8005
Mailing Address - Country:US
Mailing Address - Phone:346-476-5433
Mailing Address - Fax:
Practice Address - Street 1:4220 CARTWRIGHT RD STE 401
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5310
Practice Address - Country:US
Practice Address - Phone:346-476-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89940101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional