Healthcare Provider Details

I. General information

NPI: 1164059515
Provider Name (Legal Business Name): DAISHA C. ORCHARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAISHA L. CUMMINS

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

501 S CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7951
  • Fax:
Mailing address:
  • Phone: 801-581-7951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12407603-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: