Healthcare Provider Details

I. General information

NPI: 1215433586
Provider Name (Legal Business Name): ASHER TAKODA PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW HOLDEN ST
SEATTLE WA
98126
US

IV. Provider business mailing address

6 DUXBURY CIR
VICTOR NY
14564-1254
US

V. Phone/Fax

Practice location:
  • Phone: 585-216-7647
  • Fax:
Mailing address:
  • Phone: 585-216-7647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401958
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number60828888
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60769927
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number643918
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: