Provider Demographics
NPI:1841988193
Name:MAHANDRU, JASMEET K
Entity type:Individual
Prefix:
First Name:JASMEET
Middle Name:K
Last Name:MAHANDRU
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 1:341 FERN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7721
Mailing Address - Country:US
Mailing Address - Phone:516-852-0137
Mailing Address - Fax:
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5141
Practice Address - Country:US
Practice Address - Phone:860-585-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682078163W00000X
CT12136367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse