Provider Demographics
NPI:1689242950
Name:DORESWAMY, SHRIYA (MD)
Entity type:Individual
Prefix:
First Name:SHRIYA
Middle Name:
Last Name:DORESWAMY
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 1:2900 N I 35 STE 301
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5146
Mailing Address - Country:US
Mailing Address - Phone:940-380-8100
Mailing Address - Fax:940-380-8112
Practice Address - Street 1:2900 N INTERSTATE 35 STE 301
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5146
Practice Address - Country:US
Practice Address - Phone:940-380-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV4658207R00000X
PAMT223446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5874OtherHEALTH PARTNERS
PA236Medicaid
PA568946544OtherBCBS