Healthcare Provider Details

I. General information

NPI: 1538090311
Provider Name (Legal Business Name): KANCHANA SADASIVAN IYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 STONERIDGE DR STE 100
PLEASANTON CA
94588-3234
US

IV. Provider business mailing address

619 CINNAMON CIR
MOUNTAIN VIEW CA
94043-2090
US

V. Phone/Fax

Practice location:
  • Phone: 510-936-2614
  • Fax:
Mailing address:
  • Phone: 650-229-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: