Healthcare Provider Details

I. General information

NPI: 1447515853
Provider Name (Legal Business Name): SANDHYA MANIVANNAN GELOU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDHYA MANIVANNAN M.D.

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CORNWALL AVE STE 101
BELLINGHAM WA
98225-3676
US

IV. Provider business mailing address

2101 CORNWALL AVE STE 101
BELLINGHAM WA
98225-3676
US

V. Phone/Fax

Practice location:
  • Phone: 360-288-4343
  • Fax: 360-339-5566
Mailing address:
  • Phone: 360-288-4343
  • Fax: 360-339-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number151241
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60717353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: