Healthcare Provider Details

I. General information

NPI: 1346033826
Provider Name (Legal Business Name): SOUNITA TENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 PASEO VERDE PKWY STE 155
HENDERSON NV
89074-7120
US

IV. Provider business mailing address

5748 CHISOLM TRL
LAS VEGAS NV
89118-2055
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 562-719-3269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3676
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: