Healthcare Provider Details

I. General information

NPI: 1689461154
Provider Name (Legal Business Name): NISHI VINESH KANSARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 SOUTH GRAND BOULEVARD 2ND FLOOR GLENNON HALL, ROOM 2717
ST LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 SOUTH GRAND BOULEVARD 2ND FLOOR GLENNON HALL, ROOM 2717
ST LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5634
  • Fax: 314-577-5616
Mailing address:
  • Phone: 314-577-5634
  • Fax: 314-577-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: