Healthcare Provider Details

I. General information

NPI: 1174449094
Provider Name (Legal Business Name): KALI SATIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 UNIVERSITY BLVD
NORTH CHARLESTON SC
29406-9121
US

IV. Provider business mailing address

748 MAYNARD LN
SUMMERVILLE SC
29486-3048
US

V. Phone/Fax

Practice location:
  • Phone: 917-979-0453
  • Fax:
Mailing address:
  • Phone: 917-979-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0108249592
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: