Healthcare Provider Details

I. General information

NPI: 1639309016
Provider Name (Legal Business Name): NISREEN SADIQ MANDILAWI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CADILLAC DR STE 104
SACRAMENTO CA
95825-8350
US

IV. Provider business mailing address

25 CADILLAC DR STE 104
SACRAMENTO CA
95825-8350
US

V. Phone/Fax

Practice location:
  • Phone: 916-919-8066
  • Fax: 916-919-8066
Mailing address:
  • Phone: 916-919-8066
  • Fax: 916-919-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 24745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: