Provider Demographics
NPI:1649585159
Name:DALSETH, NATASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:DALSETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:KIRYANKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-8496
Mailing Address - Fax:215-707-4086
Practice Address - Street 1:100 E LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-8496
Practice Address - Fax:215-707-4086
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1979002084P0800X
PAMD451336103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry