Provider Demographics
NPI:1689461154
Name:KANSARA, NISHI VINESH
Entity type:Individual
Prefix:
First Name:NISHI
Middle Name:VINESH
Last Name:KANSARA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 SOUTH GRAND BOULEVARD
Mailing Address - Street 2:2ND FLOOR GLENNON HALL, ROOM 2717
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5634
Mailing Address - Fax:314-577-5616
Practice Address - Street 1:1465 SOUTH GRAND BOULEVARD
Practice Address - Street 2:2ND FLOOR GLENNON HALL, ROOM 2717
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5634
Practice Address - Fax:314-577-5616
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program