Basic Information
| Provider Information | |||||||||
| NPI: | 1609393735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | MANSI | ||||||||
| MiddleName: | SHARADKUMAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | G3169 BEECHER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176765405 | ||||||||
| FaxNumber: | 5176765460 | ||||||||
| Practice Location | |||||||||
| Address1: | G3169 BEECHER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102370799 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2017 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.021452 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 4704327956 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.