Healthcare Provider Details

I. General information

NPI: 1306295043
Provider Name (Legal Business Name): ASHA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 07/21/2022
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

IV. Provider business mailing address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-8500
  • Fax: 701-857-8637
Mailing address:
  • Phone: 701-857-8500
  • Fax: 701-857-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16518
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number16518
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: