Healthcare Provider Details

I. General information

NPI: 1265018600
Provider Name (Legal Business Name): MANISHA YEDLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 STOCKTON BLVD
SACRAMENTO CA
95817-1474
US

IV. Provider business mailing address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3574
  • Fax: 916-734-0849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA191730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: