Healthcare Provider Details

I. General information

NPI: 1760277180
Provider Name (Legal Business Name): NIYAD BASHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3469 KIMBERLY AVE
COLUMBUS OH
43224-3235
US

IV. Provider business mailing address

612 RIVER TRACE RD,
WESTERVILLE OH
43081
US

V. Phone/Fax

Practice location:
  • Phone: 614-586-2932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: