Healthcare Provider Details

I. General information

NPI: 1295501591
Provider Name (Legal Business Name): NUPUR MONDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 112TH AVE NE STE 206
BELLEVUE WA
98004-3759
US

IV. Provider business mailing address

2387 NE PARK DR
ISSAQUAH WA
98029-7401
US

V. Phone/Fax

Practice location:
  • Phone: 425-754-5135
  • Fax:
Mailing address:
  • Phone: 408-334-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: