Provider Demographics
NPI:1932305778
Name:NIDHIRY, DEEPA E (MD)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:E
Last Name:NIDHIRY
Suffix:
Gender:F
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:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-2485
Mailing Address - Country:US
Mailing Address - Phone:859-236-5366
Mailing Address - Fax:859-236-6754
Practice Address - Street 1:439 W WALNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1877
Practice Address - Country:US
Practice Address - Phone:859-236-5366
Practice Address - Fax:859-236-6754
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42286207RS0012X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1932305778OtherANTHEM BCBS
IN200934110Medicaid
KY7100067620Medicaid
KY1932305778OtherANTHEM BCBS