Provider Demographics
NPI:1346015476
Name:KESAVAPILLAI SREEDEVI, ANCHU
Entity Type:Individual
Prefix:MRS
First Name:ANCHU
Middle Name:
Last Name:KESAVAPILLAI SREEDEVI
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 1:38660 LEXINGTON ST APT 702
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-6247
Mailing Address - Country:US
Mailing Address - Phone:341-529-6108
Mailing Address - Fax:
Practice Address - Street 1:39510 PASEO PADRE PKWY STE 190
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4716
Practice Address - Country:US
Practice Address - Phone:510-403-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician