Healthcare Provider Details

I. General information

NPI: 1144134099
Provider Name (Legal Business Name): KHYATEE KAMDAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WELLNESS WAY STE G09
LATHAM NY
12110-2135
US

IV. Provider business mailing address

28 HERITAGE POINTE DR
CLIFTON PARK NY
12065-6701
US

V. Phone/Fax

Practice location:
  • Phone: 469-427-0521
  • Fax:
Mailing address:
  • Phone: 469-427-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: