Healthcare Provider Details

I. General information

NPI: 1437868759
Provider Name (Legal Business Name): PRABHLEEN KAUR PANDHER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PECAN ST SE
WASHINGTON DC
20032-2652
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 560A
SAINT LOUIS MO
63141-8261
US

V. Phone/Fax

Practice location:
  • Phone: 771-444-6200
  • Fax:
Mailing address:
  • Phone: 314-251-6440
  • Fax: 314-251-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2022048969
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200002182
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: