Provider Demographics
NPI:1558342659
Name:DE SILVA, SRIYA (MD)
Entity Type:Individual
Prefix:MS
First Name:SRIYA
Middle Name:
Last Name:DE SILVA
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 1:85 INTERSTATE 10 N STE 201
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2539
Mailing Address - Country:US
Mailing Address - Phone:409-899-1696
Mailing Address - Fax:409-833-1088
Practice Address - Street 1:85 INTERSTATE 10 N STE 201
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2539
Practice Address - Country:US
Practice Address - Phone:409-899-1696
Practice Address - Fax:409-833-1088
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF51842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133944210Medicaid
TX0016LYOtherBCBS
TX611101Medicare ID - Type Unspecified
TX133944210Medicaid