Provider Demographics
NPI:1801074950
Name:SANDHU, MINNINDER JIT (MD)
Entity type:Individual
Prefix:
First Name:MINNINDER
Middle Name:JIT
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MINNINDER
Other - Middle Name:SANDHU
Other - Last Name:KAUSHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8500 EXECUTIVE PARK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2253
Mailing Address - Country:US
Mailing Address - Phone:703-852-7020
Mailing Address - Fax:703-289-4612
Practice Address - Street 1:8500 EXECUTIVE PARK AVE STE 202
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2253
Practice Address - Country:US
Practice Address - Phone:703-852-7020
Practice Address - Fax:703-289-4612
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0583242084P0800X
VA01012593352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry