Healthcare Provider Details

I. General information

NPI: 1578428629
Provider Name (Legal Business Name): SANDHU CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 W SHAW AVE
FRESNO CA
93722-5029
US

IV. Provider business mailing address

5149 W SHAW AVE
FRESNO CA
93722-5029
US

V. Phone/Fax

Practice location:
  • Phone: 559-347-1911
  • Fax:
Mailing address:
  • Phone: 559-347-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAJDEEP SANDHU
Title or Position: OWNER
Credential: FNP-C
Phone: 559-495-5100