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Individual

SUPRIYA SHARMA KOTHAVALE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
4131 SPICEWOOD SPRINGS RD STE H2, AUSTIN, TX 78759-8659
(512) 706-9821
Mailing address
8707 RIDGEHILL DR, AUSTIN, TX 78759-7342
(908) 692-1792

Taxonomy

Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
274976
NY
2084P0015X
Psychosomatic Medicine Physician
R7510
TX
2084P0800X
Psychiatry Physician
274976
NY
2084P0800X
Psychiatry Physician
R7510
TX
2084P0804X
Child & Adolescent Psychiatry Physician
274976
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
R7510
TX

Other

Enumeration date
04/23/2010
Last updated
03/19/2024
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