Provider Demographics
NPI:1295233864
Name:PATEL, ASTHA UPENDRA
Entity type:Individual
Prefix:MS
First Name:ASTHA
Middle Name:UPENDRA
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 REMINGTON RD STE K
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4800
Mailing Address - Country:US
Mailing Address - Phone:847-496-5513
Mailing Address - Fax:
Practice Address - Street 1:3318 BAMBERG WAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6737
Practice Address - Country:US
Practice Address - Phone:281-980-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX381492355S0801X
ILRBT-24-325759106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant