Healthcare Provider Details

I. General information

NPI: 1720588742
Provider Name (Legal Business Name): LAKSHMI NAIR NP PSYCHIATRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIJAYALAKSHMI MAMMAYIL PMHNP-BC

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 W THUNDERBIRD RD STE I164
GLENDALE AZ
85306-3762
US

IV. Provider business mailing address

3003 W WINTER DR
PHOENIX AZ
85051-6689
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-2100
  • Fax:
Mailing address:
  • Phone: 631-721-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number238344
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number681075
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number238344
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402429
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number238344
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: