MEDICARE: SUMANDEEP KAUR KHEHRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	2023007520	OH

General Provider Information

NPI Number	:	1417637695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMANDEEP KAUR KHEHRA

Provider Business Mailing Address
First Line	:	10864 WATERBURY RIDGE LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-6057
Country	:	US
Telephone Number	:	513-292-3731
Fax Number	:

Provider Business Practice Location Address
First Line	:	10864 WATERBURY RIDGE LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-6057
Country	:	US
Telephone Number	:	513-292-3731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2023
Last Update Date	:	07/21/2023

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