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General NPI Number Information
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NPI Number | 1851470934
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Entity Type | Individual
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Provider Name | DEANA ANNE BHAMIDIPATI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 4900 BROAD RD HOSPITALIST OFFICE @ COMMUNITY @ UPSTATE UNIVERSITY HOS
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City | SYRAUSE
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State | NY
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Zip | 13215
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Country | US
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Telephone | 315-492-5305
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Fax | 315-492-5320
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Provider Business Mailing Address
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Address Line | 4900 BROAD RD HOSPITALIST OFFICE @ COMMUNITY @ UPSTATE UNIVERSITY HOS
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City | SYRAUSE
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State | NY
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Zip | 13215
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Country | US
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Telephone | 315-492-5305
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Fax | 315-492-5320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 011009
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110002995
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License Number State | VA
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