Provider Demographics
NPI:1679777270
Name:BOYA, GUSHYALATHA (MD)
Entity type:Individual
Prefix:
First Name:GUSHYALATHA
Middle Name:
Last Name:BOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY STE 220
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5013
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-324-4717
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0026596207R00000X
TXN2011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280010401Medicaid
TX280010402Medicaid
TX280010403Medicaid
3853840484OtherMYUTMB 3853840484-COMMERCIAL NUMBER
TXTXB124500Medicare PIN
TXTXB155579Medicare PIN
TX280010402Medicaid
TXTXB155578Medicare PIN
TXP00958574Medicare PIN