Healthcare Provider Details

I. General information

NPI: 1770076994
Provider Name (Legal Business Name): ASHLEY NITASHA BEDI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S FAIRMONT AVE
LODI CA
95240-3834
US

IV. Provider business mailing address

515 S FAIRMONT AVE
LODI CA
95240-3834
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-8570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A23542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: