Healthcare Provider Details

I. General information

NPI: 1760989974
Provider Name (Legal Business Name): NATASHA SAJEEVIKA NEAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COMMUNITY LN
SOUTHWEST HARBOR ME
04679-4273
US

IV. Provider business mailing address

16 COMMUNITY LN
SOUTHWEST HARBOR ME
04679-4273
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5630
  • Fax:
Mailing address:
  • Phone: 207-224-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLP04411
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO3264
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: