Healthcare Provider Details

I. General information

NPI: 1194157701
Provider Name (Legal Business Name): SARITA L. DHIRAPRASIDDHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-1939
  • Fax: 740-374-1693
Mailing address:
  • Phone: 614-293-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003827RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: