Individual
MR. YASHASVI MANEKTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5126 W DAYBREAK PKWY, SOUTH JORDAN, UT 84009-5994
(801) 213-5292
Mailing address
5126 W DAYBREAK PKWY, SOUTH JORDAN, UT 84009-5994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12637880-1206
UT
363AS0400X
Surgical Physician Assistant
12637880-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12637880-1206
DOPL UTAH
UT
Enumeration date
01/28/2022
Last updated
04/14/2022
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