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General NPI Number Information
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NPI Number | 1710514815
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Entity Type | Organization
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Legal Business Name | KESHAVJIVANDAS SYP, PLLC
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 12332 BEAR PLZ STE 100
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City | BURLESON
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State | TX
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Zip | 76028-0283
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Country | US
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Telephone | 817-615-8840
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Fax | 682-285-2468
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Provider Business Mailing Address
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Address Line | 6735 PLAZA VIA
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City | IRVING
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State | TX
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Zip | 75039-3224
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Country | US
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Telephone | 501-247-6003
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Fax | 682-285-2468
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. AISHA PATEL
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Credential | MBA
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Telephone | 201-214-0730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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