# ROYA MANSOORANI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1073641890
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 042-0009551 | VT | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | 0420009551 | VT | — |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 06/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1006271 | — | VT |
| 01 | — | 38096 | BLUE CROSS BLUE SHIELD | VT |