Provider Demographics
NPI:1831718972
Name:ABHILASH, DEEPA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DEEPA
Middle Name:
Last Name:ABHILASH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:GOPALAKRISHNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8558 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2562
Mailing Address - Country:US
Mailing Address - Phone:516-263-4729
Mailing Address - Fax:
Practice Address - Street 1:505 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5020
Practice Address - Country:US
Practice Address - Phone:410-341-3420
Practice Address - Fax:410-341-3397
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001421363L00000X, 363LF0000X
MDR176640363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELG-0001421OtherFAMILY NURSE PREACTIONER LICENSE NO:
MDR176640OtherCRNP-PMH LICENSE