Provider Demographics
NPI:1467143206
Name:TEEKADHARRY, VALISA KARISHMA
Entity Type:Individual
Prefix:
First Name:VALISA
Middle Name:KARISHMA
Last Name:TEEKADHARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 ROUNDHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1899
Mailing Address - Country:US
Mailing Address - Phone:952-250-6251
Mailing Address - Fax:
Practice Address - Street 1:646 ROUNDHOUSE ST
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1899
Practice Address - Country:US
Practice Address - Phone:952-250-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program