Healthcare Provider Details

I. General information

NPI: 1902020647
Provider Name (Legal Business Name): NEELAM MISRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/02/2022
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 ZACH SCOTT ST
AUSTIN TX
78723-5486
US

IV. Provider business mailing address

2611 ZACH SCOTT ST STE 208
AUSTIN TX
78723-5486
US

V. Phone/Fax

Practice location:
  • Phone: 917-412-9235
  • Fax:
Mailing address:
  • Phone: 917-403-9675
  • Fax: 281-724-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number234463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberR4598
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberR4598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: