Healthcare Provider Details

I. General information

NPI: 1134923782
Provider Name (Legal Business Name): DEEPIKA KOTHAKAPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE # 184
ALBANY NY
12208-3412
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE # 184
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-453-3079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: