Provider Demographics
NPI:1295989994
Name:BUDHRAM, ANGEL AVASHTI (PA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:AVASHTI
Last Name:BUDHRAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:AVASHTI
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1715 IRON HORSE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9617
Mailing Address - Country:US
Mailing Address - Phone:720-494-4700
Mailing Address - Fax:720-494-4706
Practice Address - Street 1:425 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1053
Practice Address - Country:US
Practice Address - Phone:512-509-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant