Healthcare Provider Details

I. General information

NPI: 1760313118
Provider Name (Legal Business Name): ADDEE BADHWA RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 ORMOND DR
SHAKOPEE MN
55379-4476
US

IV. Provider business mailing address

2050 ORMOND DR
SHAKOPEE MN
55379-4476
US

V. Phone/Fax

Practice location:
  • Phone: 952-240-4954
  • Fax:
Mailing address:
  • Phone: 952-240-4954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number1057620
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: