Provider Demographics
NPI:1538900857
Name:TALATI, EESHA
Entity type:Individual
Prefix:
First Name:EESHA
Middle Name:
Last Name:TALATI
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 1:5211 W BROAD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3000
Mailing Address - Country:US
Mailing Address - Phone:804-288-3025
Mailing Address - Fax:
Practice Address - Street 1:5211 W BROAD ST STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3000
Practice Address - Country:US
Practice Address - Phone:804-288-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant