Healthcare Provider Details

I. General information

NPI: 1740014455
Provider Name (Legal Business Name): ASHA NAYAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 MOWRY AVE STE 118A
FREMONT CA
94538-1736
US

IV. Provider business mailing address

1675 S MILPITAS BLVD APT 317
MILPITAS CA
95035-6697
US

V. Phone/Fax

Practice location:
  • Phone: 510-790-0383
  • Fax:
Mailing address:
  • Phone: 520-561-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307725
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL302568
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: