Healthcare Provider Details

I. General information

NPI: 1477199420
Provider Name (Legal Business Name): SRIDEVI BANKA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 DUBLIN BLVD STE 200
DUBLIN CA
94568-2827
US

IV. Provider business mailing address

11501 DUBLIN BLVD STE 200
DUBLIN CA
94568-2827
US

V. Phone/Fax

Practice location:
  • Phone: 510-760-9671
  • Fax: 510-495-1117
Mailing address:
  • Phone: 510-760-9671
  • Fax: 510-495-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95013560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: