Healthcare Provider Details

I. General information

NPI: 1396004792
Provider Name (Legal Business Name): DEVAKI LINDSEY BERKSON MA, CNS, DACBN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S LAKELINE BLVD STE 100
CEDAR PARK TX
78613-2968
US

IV. Provider business mailing address

PO BOX 203084
AUSTIN TX
78720-3084
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-8970
  • Fax:
Mailing address:
  • Phone: 512-507-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number11039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: