Provider Demographics
NPI:1235368184
Name:NANDYAL, DEEPA (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:
Last Name:NANDYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:GOPALAKRISHNAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 E ROSEVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3995
Mailing Address - Country:US
Mailing Address - Phone:916-783-7109
Mailing Address - Fax:
Practice Address - Street 1:1620 E ROSEVILLE PKWY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3995
Practice Address - Country:US
Practice Address - Phone:916-783-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088586207R00000X
CAA128074207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine