Healthcare Provider Details

I. General information

NPI: 1629152541
Provider Name (Legal Business Name): HIMABINDU RAVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/24/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PINNER WEALD WAY # PA
CARY NC
27513-2618
US

IV. Provider business mailing address

301 PINNER WEALD WAY
CARY NC
27513-2618
US

V. Phone/Fax

Practice location:
  • Phone: 919-346-3363
  • Fax:
Mailing address:
  • Phone: 919-346-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number2003-00281
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC160213
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20030081
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2003-00281
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: