Basic Information
| Provider Information | |||||||||
| NPI: | 1306466917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANDE | ||||||||
| FirstName: | KALYANI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 481 W AUDUBON DR APT 241 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937116269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602342748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40131 CA-49 | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596832244 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2020 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP28705 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.