Provider Demographics
NPI:1285067355
Name:PRASAI BERLIN, PRAVEENA (APRNCNP)
Entity type:Individual
Prefix:
First Name:PRAVEENA
Middle Name:
Last Name:PRASAI BERLIN
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:PRAVEENA
Other - Middle Name:
Other - Last Name:PRASAI SHARMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRNCNP
Mailing Address - Street 1:PO BOX 844020
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4020
Mailing Address - Country:US
Mailing Address - Phone:216-450-1613
Mailing Address - Fax:
Practice Address - Street 1:25700 SCIENCE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7328
Practice Address - Country:US
Practice Address - Phone:216-450-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.16991363LF0000X, 363LP0808X
LA3008238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0128206Medicaid