Provider Demographics
NPI:1679049704
Name:DEDA, XHENI (MD)
Entity Type:Individual
Prefix:
First Name:XHENI
Middle Name:
Last Name:DEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HOSPITAL DRIVE,
Mailing Address - Street 2:CE 405, DC 043.00
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212
Mailing Address - Country:US
Mailing Address - Phone:573-882-8586
Mailing Address - Fax:
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:CE405 DC043.00
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-2081
Practice Address - Country:US
Practice Address - Phone:573-882-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2022023800207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program