Healthcare Provider Details

I. General information

NPI: 1265356885
Provider Name (Legal Business Name): ASHA BETTADAPUR CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 RIVERRUN DR
SAN JOSE CA
95127-1880
US

IV. Provider business mailing address

19794 MERRIBROOK DR
SARATOGA CA
95070-5454
US

V. Phone/Fax

Practice location:
  • Phone: 408-573-3000
  • Fax:
Mailing address:
  • Phone: 669-212-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: