Provider Demographics
NPI:1528406535
Name:ZACHARIAH, DEEPTHY ROY (NP)
Entity Type:Individual
Prefix:
First Name:DEEPTHY
Middle Name:ROY
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 PRESTON RD
Mailing Address - Street 2:SUITE 350, PMB2
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7453
Mailing Address - Country:US
Mailing Address - Phone:214-947-5000
Mailing Address - Fax:214-947-5040
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-5000
Practice Address - Fax:214-947-5040
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX819412363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311105YTJDMedicare PIN