Healthcare Provider Details

I. General information

NPI: 1851203533
Provider Name (Legal Business Name): AKSHAY MISRA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3535 MARKET ST FL 2
PHILADELPHIA PA
19104-3317
US

IV. Provider business mailing address

3535 MARKET ST FL 2
PHILADELPHIA PA
19104-3317
US

V. Phone/Fax

Practice location:
  • Phone: 215-746-6701
  • Fax:
Mailing address:
  • Phone: 215-746-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPS020840
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: