Provider Demographics
NPI:1932874625
Name:MOHINDROO, ATYSHA
Entity Type:Individual
Prefix:
First Name:ATYSHA
Middle Name:
Last Name:MOHINDROO
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 1:1625 LEHIGH PKWY E APT 303
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3064
Mailing Address - Country:US
Mailing Address - Phone:323-831-4626
Mailing Address - Fax:
Practice Address - Street 1:101 N 6TH ST STE 310
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1403
Practice Address - Country:US
Practice Address - Phone:323-831-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist