Provider Demographics
NPI:1801443452
Name:PRADHAN, JALASHREE (LAC)
Entity type:Individual
Prefix:
First Name:JALASHREE
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 PILLSBURY AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4329
Mailing Address - Country:US
Mailing Address - Phone:612-396-2997
Mailing Address - Fax:
Practice Address - Street 1:5000 W 36TH ST STE 120
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-2775
Practice Address - Country:US
Practice Address - Phone:612-922-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1191171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist