Healthcare Provider Details

I. General information

NPI: 1508789868
Provider Name (Legal Business Name): SANDEEP KAUR MANGAT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 NORTHLAND DR STE 400
AUSTIN TX
78731-4990
US

IV. Provider business mailing address

3305 NORTHLAND DR STE 400
AUSTIN TX
78731-4990
US

V. Phone/Fax

Practice location:
  • Phone: 512-343-5555
  • Fax:
Mailing address:
  • Phone: 512-343-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1230609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: