Healthcare Provider Details

I. General information

NPI: 1881003143
Provider Name (Legal Business Name): MAI KARITANI MANCHANDA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E 1ST ST
NEWTON KS
67114-5010
US

IV. Provider business mailing address

200 E HACIENDA AVE
CAMPBELL CA
95008-6617
US

V. Phone/Fax

Practice location:
  • Phone: 316-284-6400
  • Fax:
Mailing address:
  • Phone: 408-871-5840
  • Fax: 408-871-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: