Healthcare Provider Details

I. General information

NPI: 1528761830
Provider Name (Legal Business Name): DEEPESH SUBEDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 N BRIDGE ST
CHILLICOTHEE OH
45601-1704
US

IV. Provider business mailing address

879 N BRIDGE ST
CHILLICOTHEE OH
45601-1704
US

V. Phone/Fax

Practice location:
  • Phone: 740-772-5050
  • Fax: 740-772-5051
Mailing address:
  • Phone: 740-772-5050
  • Fax: 740-772-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number35528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: