Provider Demographics
NPI:1396004792
Name:BERKSON, DEVAKI LINDSEY (MA, CNS, DACBN)
Entity Type:Individual
Prefix:
First Name:DEVAKI
Middle Name:LINDSEY
Last Name:BERKSON
Suffix:
Gender:F
Credentials:MA, CNS, DACBN
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 203084
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-3084
Mailing Address - Country:US
Mailing Address - Phone:512-507-3279
Mailing Address - Fax:
Practice Address - Street 1:2500 S LAKELINE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2968
Practice Address - Country:US
Practice Address - Phone:512-345-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11039133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist