Basic Information
| Provider Information | |||||||||
| NPI: | 1992150189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORADIA | ||||||||
| FirstName: | NISHIKA | ||||||||
| MiddleName: | SHINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 S SKINKER BLVD APT 603 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631053270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197980047 | ||||||||
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| Practice Location | |||||||||
| Address1: | EAST TENNESSEE STATE UNIVERSITY QUILLEN COLLEGE OF MEDI | ||||||||
| Address2: | DOGWOOD AVE, BUILDING 1, ROOM 249 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396266 | ||||||||
| FaxNumber: | 4234396259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.