Healthcare Provider Details

I. General information

NPI: 1194611145
Provider Name (Legal Business Name): SAI BRIGISHA KYASA M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 23RD AVE SOUTH SUITE 200
FARGO ND
58104
US

IV. Provider business mailing address

2850 UPTOWN WAY SOUTH LYV UPTOWN & MAINS APARTMENT -216.
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-4193
  • Fax:
Mailing address:
  • Phone: 734-262-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRL22593
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: