Provider Demographics
NPI:1700672888
Name:MANDAVA, LIKHITH SAI
Entity type:Individual
Prefix:
First Name:LIKHITH SAI
Middle Name:
Last Name:MANDAVA
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 1:205 N EAST AVE, HENRY FORD JACKSON HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-205-7116
Mailing Address - Fax:517-205-7050
Practice Address - Street 1:205 N EAST AVE, HENRY FORD JACKSON HOSPITAL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-205-7116
Practice Address - Fax:517-205-7050
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program