Provider Demographics
NPI:1710514815
Name:KESHAVJIVANDAS SYP, PLLC
Entity Type:Organization
Organization Name:KESHAVJIVANDAS SYP, PLLC
Other - Org Name:INTERVENTIONAL PAIN AND SPINE OF GREATER DFW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:201-214-0730
Mailing Address - Street 1:6735 PLAZA VIA
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3224
Mailing Address - Country:US
Mailing Address - Phone:501-247-6003
Mailing Address - Fax:682-285-2468
Practice Address - Street 1:12332 BEAR PLZ STE 100
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0283
Practice Address - Country:US
Practice Address - Phone:817-615-8840
Practice Address - Fax:682-285-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain