Provider Demographics
NPI:1669886347
Name:KHANDHADIYA, NEHA
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:KHANDHADIYA
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 1:723 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1811
Mailing Address - Country:US
Mailing Address - Phone:201-839-7851
Mailing Address - Fax:
Practice Address - Street 1:4265 UNION DEPOSIT RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2802
Practice Address - Country:US
Practice Address - Phone:717-683-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040029122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentist