Provider Demographics
NPI:1417351545
Name:MISHRA, SRIKANTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SRIKANTA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:M
Credentials:PHD
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 30001, MSC 3SPE, NEW MEXICO STATE UNIVERSITY
Mailing Address - Street 2:DEPARTMENT OF SPED & COMMUNICATION DISORDERS
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8001
Mailing Address - Country:US
Mailing Address - Phone:575-646-7831
Mailing Address - Fax:575-646-7712
Practice Address - Street 1:1405 INTERNATIONAL MALL
Practice Address - Street 2:SPEECH BUILDING ROOM 158
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:575-646-3906
Practice Address - Fax:575-646-7712
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5641231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist