Provider Demographics
NPI:1326304908
Name:BATISTA, MAYA IRENE SRIMUSHNAM (MD)
Entity Type:Individual
Prefix:MISS
First Name:MAYA
Middle Name:IRENE SRIMUSHNAM
Last Name:BATISTA
Suffix:
Gender:F
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:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-1515
Mailing Address - Country:US
Mailing Address - Phone:661-262-7479
Mailing Address - Fax:661-249-6881
Practice Address - Street 1:6201 OVERTON RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3613
Practice Address - Country:US
Practice Address - Phone:817-222-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5651208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty