Healthcare Provider Details

I. General information

NPI: 1831952613
Provider Name (Legal Business Name): SRIDEVI VEERAMASUNENI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 N COLLINS BLVD
RICHARDSON TX
75080-2695
US

IV. Provider business mailing address

10 LINCOLN SQ
WORCESTER MA
01608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 508-373-5607
  • Fax:
Mailing address:
  • Phone: 508-373-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA101918
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: