Healthcare Provider Details

I. General information

NPI: 1760157093
Provider Name (Legal Business Name): ALISHA THADANI RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date: 11/07/2024
Reactivation Date: 12/03/2024

III. Provider practice location address

5000 RESEARCH CT STE 450
SUWANEE GA
30024-6660
US

IV. Provider business mailing address

3325 GREENFERN CT
ALPHARETTA GA
30004-8479
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-179514
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: