Provider Demographics
NPI:1619554177
Name:MANDYAM, SAIKIRAN
Entity type:Individual
Prefix:
First Name:SAIKIRAN
Middle Name:
Last Name:MANDYAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LEHIGH AVE UNIT 304
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3967
Mailing Address - Country:US
Mailing Address - Phone:909-330-9253
Mailing Address - Fax:
Practice Address - Street 1:1945 NJ-33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:732-775-5500
Practice Address - Fax:334-305-0219
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12170600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine