Basic Information
| Provider Information | |||||||||
| NPI: | 1619057601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANKAD | ||||||||
| FirstName: | VAISHALI | ||||||||
| MiddleName: | SUKHANI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2446 | ||||||||
| Address2: | |||||||||
| City: | SKYLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287762446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752644 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 10880 DURANT RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276146628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198460800 | ||||||||
| FaxNumber: | 9198460880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 2001-00165 | NC | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 7433321 | 01 | NC | AETNA | OTHER | 2287753C | 01 | NC | MEDICARE PTAN | OTHER | P00643303 | 01 | NC | RAILROAD MEDICARE | OTHER | 891289U | 05 | NC | MEDICAID | FH2200230 | 01 | NC | FIRST CAROLINA CARE | OTHER |