MEDICARE: DR. MAYA IRENE SRIMUSHNAM BATISTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	R5651	TX
2	208600000X	Surgery Physician	R5651	TX

General Provider Information

NPI Number	:	1326304908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYA IRENE SRIMUSHNAM BATISTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 842861
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-2861
Country	:	US
Telephone Number	:	817-764-1554
Fax Number	:	817-764-1565

Provider Business Practice Location Address
First Line	:	5668 EDWARDS RANCH RD STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4109
Country	:	US
Telephone Number	:	817-764-1554
Fax Number	:	817-764-1565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2012
Last Update Date	:	09/04/2025

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