Healthcare Provider Details

I. General information

NPI: 1699222992
Provider Name (Legal Business Name): SUJATA MANKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 MANOR GLEN WAY
GLEN ALLEN VA
23059-7155
US

IV. Provider business mailing address

4610 MANOR GLEN WAY
GLEN ALLEN VA
23059-7155
US

V. Phone/Fax

Practice location:
  • Phone: 646-339-3764
  • Fax:
Mailing address:
  • Phone: 646-339-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216355
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: