Healthcare Provider Details

I. General information

NPI: 1528406535
Provider Name (Legal Business Name): DEEPTHY ROY ZACHARIAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE
DALLAS TX
75203-1201
US

IV. Provider business mailing address

3308 PRESTON RD SUITE 350, PMB2
PLANO TX
75093-7453
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-5000
  • Fax: 214-947-5040
Mailing address:
  • Phone: 214-947-5000
  • Fax: 214-947-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number819412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: