Healthcare Provider Details

I. General information

NPI: 1609156801
Provider Name (Legal Business Name): SAKSHI VAISHNAV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 01/18/2022
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST STE 100
CHARLESTON WV
25301-1840
US

IV. Provider business mailing address

415 MORRIS ST STE 100
CHARLESTON WV
25301-1840
US

V. Phone/Fax

Practice location:
  • Phone: 269-568-8868
  • Fax: 304-388-7820
Mailing address:
  • Phone: 304-388-7821
  • Fax: 304-388-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301098142
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301098142
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01076456A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number30819
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: