Provider Demographics
NPI:1366685703
Name:PRASERTVIT, SIRINYA (MD)
Entity Type:Individual
Prefix:
First Name:SIRINYA
Middle Name:
Last Name:PRASERTVIT
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 1:701 N UNIVERSITY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2936
Mailing Address - Country:US
Mailing Address - Phone:501-664-2434
Mailing Address - Fax:501-907-7768
Practice Address - Street 1:701 N UNIVERSITY AVE STE 203
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2936
Practice Address - Country:US
Practice Address - Phone:501-664-2434
Practice Address - Fax:501-907-7768
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51874208600000X
ARE-13041208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery