Healthcare Provider Details

I. General information

NPI: 1295233864
Provider Name (Legal Business Name): MS. ASTHA UPENDRA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 BAMBERG WAY
SUGAR LAND TX
77479-6737
US

IV. Provider business mailing address

1300 REMINGTON RD STE K
SCHAUMBURG IL
60173-4800
US

V. Phone/Fax

Practice location:
  • Phone: 281-980-5692
  • Fax:
Mailing address:
  • Phone: 847-496-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number38149
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-325759
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: