Provider Demographics
NPI:1811133762
Name:SRINIVASAN, DEEPIKA (PA-C)
Entity type:Individual
Prefix:MS
First Name:DEEPIKA
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-485-5889
Mailing Address - Fax:512-420-0397
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:SUITE 4-A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1251
Practice Address - Country:US
Practice Address - Phone:512-448-4588
Practice Address - Fax:512-445-4511
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10151363A00000X
CT003216363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant