Provider Demographics
NPI:1700120995
Name:PRAYAGA, SRIKANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIKANTH
Middle Name:
Last Name:PRAYAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3201
Mailing Address - Country:US
Mailing Address - Phone:707-649-4024
Mailing Address - Fax:
Practice Address - Street 1:525 OREGON ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3201
Practice Address - Country:US
Practice Address - Phone:707-649-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1585032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry