Provider Demographics
NPI:1093247405
Name:DATTA, NEHA (MD)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:DATTA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 313
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4687
Mailing Address - Country:US
Mailing Address - Phone:708-923-7878
Mailing Address - Fax:708-923-7888
Practice Address - Street 1:15300 WEST AVE STE 313
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4687
Practice Address - Country:US
Practice Address - Phone:708-923-7878
Practice Address - Fax:708-923-7888
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3098592084P0800X
IL0361557572084A0401X
VA01012784372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry