Provider Demographics
NPI:1851470934
Name:BHAMIDIPATI, DEANA ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:ANNE
Last Name:BHAMIDIPATI
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:4900 BROAD RD
Mailing Address - Street 2:HOSPITALIST OFFICE @ COMMUNITY @ UPSTATE UNIVERSITY HOS
Mailing Address - City:SYRAUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215
Mailing Address - Country:US
Mailing Address - Phone:315-492-5305
Mailing Address - Fax:315-492-5320
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:HOSPITALIST OFFICE @ COMMUNITY @ UPSTATE UNIVERSITY HOS
Practice Address - City:SYRAUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-492-5305
Practice Address - Fax:315-492-5320
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011009363A00000X
VA0110002995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ66508Medicare UPIN
NYPA1322Medicare PIN
NYP00435272Medicare PIN