Healthcare Provider Details

I. General information

NPI: 1639099336
Provider Name (Legal Business Name): TANISI AMIT MITTAL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N KEENE ST
COLUMBIA MO
65201-8367
US

IV. Provider business mailing address

525 N KEENE ST
COLUMBIA MO
65201-8367
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-7903
  • Fax: 573-884-4607
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: