Provider Demographics
NPI:1699967893
Name:SRIYA DESILVA
Entity type:Organization
Organization Name:SRIYA DESILVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-899-1696
Mailing Address - Street 1:85 INTERSTATE 10 N STE 201
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2539
Mailing Address - Country:US
Mailing Address - Phone:409-899-1696
Mailing Address - Fax:409-833-1088
Practice Address - Street 1:85 INTERSTATE 10 N STE 201
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2539
Practice Address - Country:US
Practice Address - Phone:409-899-1696
Practice Address - Fax:409-833-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF51842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016LYOtherBCBS OF TX
TX0016LYOtherBCBS OF TX
TX611101Medicare PIN